Provider Demographics
NPI:1245202118
Name:ROMERO, ROSA
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:
Last Name: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 1:608 S SAINT VRAIN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79901
Mailing Address - Country:US
Mailing Address - Phone:915-534-7979
Mailing Address - Fax:519-534-7601
Practice Address - Street 1:1313 SAN ANTONIO
Practice Address - Street 2:
Practice Address - City:SAN ELIZARION
Practice Address - State:TX
Practice Address - Zip Code:79849
Practice Address - Country:US
Practice Address - Phone:915-851-5519
Practice Address - Fax:915-533-4878
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19098122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist