1619538683 NPI number — GABRIELLA NICOLE ROMERO PA-C, MSPAS

Table of content: GABRIELLA NICOLE ROMERO PA-C, MSPAS (NPI 1619538683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619538683 NPI number — GABRIELLA NICOLE ROMERO PA-C, MSPAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMERO
Provider First Name:
GABRIELLA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C, MSPAS
Provider Gender Code:
F

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:
1619538683
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1406 SE 164TH AVE
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98683
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-940-0810
Provider Business Mailing Address Fax Number:
360-597-3436

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 116TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-209-0840
Provider Business Practice Location Address Fax Number:
425-209-0778
Provider Enumeration Date:
06/21/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207K00000X , with the licence number: PA60972448 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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