Provider Demographics
NPI:1174879167
Name:ROMERO, PAMELA (RD, LDN, CDE)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5618 GREENSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-1421
Mailing Address - Country:US
Mailing Address - Phone:225-751-7475
Mailing Address - Fax:
Practice Address - Street 1:628 N 4TH ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-5342
Practice Address - Country:US
Practice Address - Phone:225-342-7901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA391133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered