1841463353 NPI number — ELIOTT ROMERO, MD CORP

Table of content: (NPI 1841463353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841463353 NPI number — ELIOTT ROMERO, MD CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELIOTT ROMERO, MD CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1841463353
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
57340 29 PALMS HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUCCA VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92284-2927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-365-2308
Provider Business Mailing Address Fax Number:
760-365-7538

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
57340 29 PALMS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUCCA VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92284-2927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-365-2308
Provider Business Practice Location Address Fax Number:
760-365-7538
Provider Enumeration Date:
04/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ROMERO
Authorized Official First Name:
ELIOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
PROPRIETOR
Authorized Official Telephone Number:
760-365-2308

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  G48383 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207VX0000X , with the licence number: G48383 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 193200000X . This is a "TAXONOMY CODE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1841463353 . This is a "NPI SUBPART" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 207VX0000X . This is a "TAXONOMY CODE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1942361548 . This is a "NPI INDIVIDUAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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