Provider Demographics
NPI:1215012158
Name:ROMERO, ROCKY J (OTR L)
Entity Type:Individual
Prefix:MR
First Name:ROCKY
Middle Name:J
Last Name:ROMERO
Suffix:
Gender:M
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11395 JAMES WATT DR
Mailing Address - Street 2:#A-7
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5940
Mailing Address - Country:US
Mailing Address - Phone:915-598-1920
Mailing Address - Fax:915-598-2444
Practice Address - Street 1:11395 JAMES WATT DR
Practice Address - Street 2:#A-7
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5940
Practice Address - Country:US
Practice Address - Phone:915-598-1920
Practice Address - Fax:915-598-2444
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102637225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0877714-01Medicaid
TX112259OtherSUPERIOR HEALTHPLAN, INC
TX00002207HMOtherBLUECROSS BLUESHIELD OF T
TX0877714-01Medicaid
TXR59482Medicare UPIN