Provider Demographics
NPI:1003171604
Name:ROMERO DE MONTERO, CRISTINA CAROLINA (MD)
Entity Type:Individual
Prefix:DR
First Name:CRISTINA
Middle Name:CAROLINA
Last Name:ROMERO DE MONTERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CRISTINA
Other - Middle Name:CAROLINA
Other - Last Name:ROMERO HENRIQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:30300 CAMINO CAPISTRANO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1304
Mailing Address - Country:US
Mailing Address - Phone:949-240-2030
Mailing Address - Fax:949-240-5869
Practice Address - Street 1:30300 CAMINO CAPISTRANO
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1304
Practice Address - Country:US
Practice Address - Phone:949-240-2030
Practice Address - Fax:949-240-5869
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA137934208000000X
NY265643208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400078565Medicare PIN