1245956184 NPI number — MIRTHA ROMERO COTA

Table of content: MIRTHA ROMERO COTA (NPI 1245956184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245956184 NPI number — MIRTHA ROMERO COTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMERO
Provider First Name:
MIRTHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
COTA
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:
1245956184
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5326 5TH ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22203-1304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-319-9178
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10714 BALTIMORE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELTSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20705-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-542-4420
Provider Business Practice Location Address Fax Number:
240-542-4434
Provider Enumeration Date:
10/12/2022

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: 171W00000X , with the licence number:  A03073 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: A03073 . This is a "COTA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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