Provider Demographics
NPI:1619194586
Name:ROMERO, CAROL HOLLIS (RN,NP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:HOLLIS
Last Name:ROMERO
Suffix:
Gender:F
Credentials:RN,NP
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:JANE
Other - Last Name:HOLLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,NP
Mailing Address - Street 1:333 S TWIN OAKS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92096-0001
Mailing Address - Country:US
Mailing Address - Phone:760-750-4915
Mailing Address - Fax:760-750-3181
Practice Address - Street 1:333 S TWIN OAKS VALLEY RD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92096-0001
Practice Address - Country:US
Practice Address - Phone:760-750-4915
Practice Address - Fax:760-750-3181
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA388433363L00000X
CA10252363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA388433Medicare UPIN