Provider Demographics
NPI:1598448433
Name:ROMERO, TATIANA MARGARITA (CEO)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:MARGARITA
Last Name:ROMERO
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:AUGUSTO
Other - Middle Name:JOSE
Other - Last Name:ARTEAGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1815 PORTOFINO BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824
Mailing Address - Country:US
Mailing Address - Phone:321-310-0523
Mailing Address - Fax:
Practice Address - Street 1:1815 PORTOFINO BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824
Practice Address - Country:US
Practice Address - Phone:321-310-0523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver