Provider Demographics
NPI:1083764518
Name:ROMERO, DEANNA T
Entity Type:Individual
Prefix:PROF
First Name:DEANNA
Middle Name:T
Last Name:ROMERO
Suffix:
Gender:F
Credentials:
Other - Prefix:PROF
Other - First Name:DEANA
Other - Middle Name:T
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:203 S ROLLIE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LUPTON
Mailing Address - State:CO
Mailing Address - Zip Code:80621-1508
Mailing Address - Country:US
Mailing Address - Phone:303-286-4560
Mailing Address - Fax:303-286-4589
Practice Address - Street 1:6255 N QUEBEC PKWY
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022
Practice Address - Country:US
Practice Address - Phone:303-286-8900
Practice Address - Fax:303-286-6755
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO485363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant