1801899448 NPI number — MS. PATRICIA GAIL ROMO CNM

Table of content: MS. PATRICIA GAIL ROMO CNM (NPI 1801899448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801899448 NPI number — MS. PATRICIA GAIL ROMO CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMO
Provider First Name:
PATRICIA
Provider Middle Name:
GAIL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
URBANSKI
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
R. KING
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801899448
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1266 N AMBROSIA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85205-4353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-654-3312
Provider Business Mailing Address Fax Number:
480-654-3312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1492 S MILL AVE
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85281-5652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-559-4776
Provider Business Practice Location Address Fax Number:
480-907-1686
Provider Enumeration Date:
05/27/2005

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: 176B00000X , with the licence number:  CM445 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: AP2342 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 364S00000X , with the licence number: R23590 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 9956547 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1995657 . This is a "HEALTH CHOICE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: V995657.06 . This is a "MARICOPA HEALTH PLAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 11631036 . This is a "CAQH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 995657 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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