Provider Demographics
NPI:1013415983
Name:SANTACRUZ ROMERO, ODALISS V
Entity Type:Individual
Prefix:
First Name:ODALISS
Middle Name:V
Last Name:SANTACRUZ ROMERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 TALUS WAY APT A105
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-1269
Mailing Address - Country:US
Mailing Address - Phone:775-287-4867
Mailing Address - Fax:
Practice Address - Street 1:250 TALUS WAY APT A105
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-1269
Practice Address - Country:US
Practice Address - Phone:775-287-4867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide