Provider Demographics
NPI:1407040173
Name:ROMERO MEDINA, MARIALBA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIALBA
Middle Name:
Last Name:ROMERO MEDINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIALBA
Other - Middle Name:
Other - Last Name:ROMERO MEDINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:REPARTO APOLO
Mailing Address - Street 2:PP9 CALLE ARTEMISA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 S RAISINVILLE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161
Practice Address - Country:US
Practice Address - Phone:800-886-7340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11808 I207R00000X
PR178822084P0804X
MI43011144542084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine