Provider Demographics
NPI:1497243521
Name:BECERRIL ROMERO, CARLOS CESAR
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:CESAR
Last Name:BECERRIL ROMERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-9674
Mailing Address - Country:US
Mailing Address - Phone:708-691-0906
Mailing Address - Fax:
Practice Address - Street 1:705 RILEY HOSPITAL DR RM 5867
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-944-4034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program