1215012158 NPI number — MR. ROCKY J ROMERO OTR L

Table of content: MR. ROCKY J ROMERO OTR L (NPI 1215012158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215012158 NPI number — MR. ROCKY J ROMERO OTR L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMERO
Provider First Name:
ROCKY
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
OTR L
Provider Gender Code:
M

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:
1215012158
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11395 JAMES WATT DR
Provider Second Line Business Mailing Address:
#A-7
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79936-5940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-598-1920
Provider Business Mailing Address Fax Number:
915-598-2444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11395 JAMES WATT DR
Provider Second Line Business Practice Location Address:
#A-7
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79936-5940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-598-1920
Provider Business Practice Location Address Fax Number:
915-598-2444
Provider Enumeration Date:
10/26/2006

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: 225XH1200X , with the licence number:  102637 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0877714-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112259 . This is a "SUPERIOR HEALTHPLAN, INC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00002207HM . This is a "BLUECROSS BLUESHIELD OF T" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com