Provider Demographics
NPI:1508543570
Name:SALINA ROMERO, MAITE (MD)
Entity Type:Individual
Prefix:
First Name:MAITE
Middle Name:
Last Name:SALINA ROMERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9827 ELM WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-1081
Mailing Address - Country:US
Mailing Address - Phone:813-455-7769
Mailing Address - Fax:
Practice Address - Street 1:11211 N NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5777
Practice Address - Country:US
Practice Address - Phone:305-278-0200
Practice Address - Fax:305-851-4110
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1549208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty