Provider Demographics
NPI:1477305977
Name:ROMO DE RUIZ, SOCORRO (COMMUNITY HEALTH)
Entity Type:Individual
Prefix:
First Name:SOCORRO
Middle Name:
Last Name:ROMO DE RUIZ
Suffix:
Gender:F
Credentials:COMMUNITY HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 E GILBERT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-5325
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:217 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1438
Practice Address - Country:US
Practice Address - Phone:951-273-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker