Provider Demographics
NPI:1659725588
Name:ROMERO, MLINDSEY (DO)
Entity Type:Individual
Prefix:
First Name:MLINDSEY
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 S EAST BAY BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-6142
Mailing Address - Country:US
Mailing Address - Phone:385-375-8724
Mailing Address - Fax:
Practice Address - Street 1:3311 N UNIVERSITY AVE STE 275
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-7407
Practice Address - Country:US
Practice Address - Phone:385-325-2370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11961059-1204208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty