Provider Demographics
NPI:1710871694
Name:ROMAIN, TINA JUNE
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:JUNE
Last Name:ROMAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3933 TIVOLI AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-4109
Mailing Address - Country:US
Mailing Address - Phone:310-902-1403
Mailing Address - Fax:
Practice Address - Street 1:355 S GRAND AVE FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90071-1560
Practice Address - Country:US
Practice Address - Phone:213-891-7878
Practice Address - Fax:213-891-7878
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10921363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health