Provider Demographics
NPI:1225739303
Name:MONTOYA ROMERO, EVELIN JESSICA
Entity Type:Individual
Prefix:
First Name:EVELIN
Middle Name:JESSICA
Last Name:MONTOYA 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 1:11702 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5442
Mailing Address - Country:US
Mailing Address - Phone:216-671-1411
Mailing Address - Fax:216-941-3483
Practice Address - Street 1:11702 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5442
Practice Address - Country:US
Practice Address - Phone:216-671-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09200327183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician