Provider Demographics
NPI:1033520002
Name:ROMERO LOPEZ, ADAN DE JESUS (MD)
Entity Type:Individual
Prefix:
First Name:ADAN DE JESUS
Middle Name:
Last Name:ROMERO LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1559
Mailing Address - Street 2:CLINICA SIERRA VISTA
Mailing Address - City:BAKESFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301
Mailing Address - Country:US
Mailing Address - Phone:661-869-1503
Mailing Address - Fax:661-869-1503
Practice Address - Street 1:9001 SOUTH H ST
Practice Address - Street 2:CLINICA SIERRA VISTA
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307
Practice Address - Country:US
Practice Address - Phone:661-328-4260
Practice Address - Fax:661-617-2881
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA144650207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine