Provider Demographics
NPI:1124761333
Name:ROWENA LAGLEVA ROMERO
Entity type:Organization
Organization Name:ROWENA LAGLEVA ROMERO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:ROWENA
Authorized Official - Middle Name:LAGLEVA
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-787-8976
Mailing Address - Street 1:1102 E 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2139
Mailing Address - Country:US
Mailing Address - Phone:650-787-8976
Mailing Address - Fax:
Practice Address - Street 1:777 HICKEY BLVD
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-1214
Practice Address - Country:US
Practice Address - Phone:650-359-7720
Practice Address - Fax:650-359-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental