Provider Demographics
NPI:1467647073
Name:ROMEGA, EMILIA (N/A)
Entity Type:Individual
Prefix:MRS
First Name:EMILIA
Middle Name:
Last Name:ROMEGA
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13212 N 7TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-1805
Mailing Address - Country:US
Mailing Address - Phone:602-547-0389
Mailing Address - Fax:602-938-0839
Practice Address - Street 1:13212 N 7TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-1805
Practice Address - Country:US
Practice Address - Phone:602-547-0389
Practice Address - Fax:602-938-0839
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-5519310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ809197Medicaid