1629319546 NPI number — RACHEL LAUREN ROMERO MOT, OTR

Table of content: RACHEL LAUREN ROMERO MOT, OTR (NPI 1629319546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629319546 NPI number — RACHEL LAUREN ROMERO MOT, OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMERO
Provider First Name:
RACHEL
Provider Middle Name:
LAUREN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MOT, OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SILVERMAN
Provider Other First Name:
RACHEL
Provider Other Middle Name:
LAUREN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MOT, OTR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629319546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14291 SW 120TH ST STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33186-7287
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-385-0168
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14291 SW 120TH ST
Provider Second Line Business Practice Location Address:
SUITE #103
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-385-0168
Provider Business Practice Location Address Fax Number:
305-385-0182
Provider Enumeration Date:
03/04/2013

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: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 008268200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".