1114032208 NPI number — JESUSA N ROMERO MD A PROFESSIONAL CORPORATION

Table of content: (NPI 1114032208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114032208 NPI number — JESUSA N ROMERO MD A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JESUSA N ROMERO MD A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114032208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9321 FLORENCE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90240-3508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-804-5295
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10230 ARTESIA BLVD
Provider Second Line Business Practice Location Address:
STE 209
Provider Business Practice Location Address City Name:
BELLFLOWER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90706-6763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-804-5295
Provider Business Practice Location Address Fax Number:
562-504-5296
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROMERO
Authorized Official First Name:
JESUSA
Authorized Official Middle Name:
NAVARRO
Authorized Official Title or Position:
OWNER/MD
Authorized Official Telephone Number:
562-804-5295

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  A34299 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A34299 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A342991 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05D0705610 . This is a "CLIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com