Provider Demographics
NPI:1689003477
Name:ROMERO, DOLORES
Entity Type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:
Last Name:ROMERO
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 1:1711 E EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3349
Mailing Address - Country:US
Mailing Address - Phone:719-566-0234
Mailing Address - Fax:719-564-7212
Practice Address - Street 1:4 MONTEBELLO RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1237
Practice Address - Country:US
Practice Address - Phone:719-546-6667
Practice Address - Fax:719-546-8273
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7088101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)