Provider Demographics
NPI:1558868539
Name:ROMAR, TINEISHA DESHAY
Entity Type:Individual
Prefix:
First Name:TINEISHA
Middle Name:DESHAY
Last Name:ROMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 DRUMMOND ST
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-2584
Mailing Address - Country:US
Mailing Address - Phone:409-549-0482
Mailing Address - Fax:
Practice Address - Street 1:601 DRUMMOND ST
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-2584
Practice Address - Country:US
Practice Address - Phone:409-549-0482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23828897343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)