Provider Demographics
NPI:1588635759
Name:ROMERO, AMBROSIO JESUS (MD, FAAFP)
Entity Type:Individual
Prefix:DR
First Name:AMBROSIO
Middle Name:JESUS
Last Name:ROMERO
Suffix:
Gender:M
Credentials:MD, FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 BOOTHE CIR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-6774
Mailing Address - Country:US
Mailing Address - Phone:844-665-4827
Mailing Address - Fax:
Practice Address - Street 1:1908 BOOTHE CIR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-6774
Practice Address - Country:US
Practice Address - Phone:844-665-4827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059052207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004258600Medicaid
FL11782VMedicare PIN
FLD34262Medicare UPIN
FL11782Medicare ID - Type UnspecifiedMEDICARE PROVIDER