Provider Demographics
NPI:1235441650
Name:ROMO, LORI J (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:J
Last Name:ROMO
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:J
Other - Last Name:RICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD,CDE
Mailing Address - Street 1:PO BOX 17779
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85269-7779
Mailing Address - Country:US
Mailing Address - Phone:480-789-7890
Mailing Address - Fax:480-837-1270
Practice Address - Street 1:16240 NORTH FORT MCDOWELL ROAD
Practice Address - Street 2:
Practice Address - City:FORT MCDOWELL
Practice Address - State:AZ
Practice Address - Zip Code:85264
Practice Address - Country:US
Practice Address - Phone:480-789-7890
Practice Address - Fax:480-837-1270
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ993389133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered