Provider Demographics
NPI:1790839124
Name:ROMERO, DORIS RUTH (DOM)
Entity Type:Individual
Prefix:MS
First Name:DORIS
Middle Name:RUTH
Last Name:ROMERO
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 GOLD MINE RD
Mailing Address - Street 2:
Mailing Address - City:CERRILLOS
Mailing Address - State:NM
Mailing Address - Zip Code:87010-9717
Mailing Address - Country:US
Mailing Address - Phone:505-670-1841
Mailing Address - Fax:
Practice Address - Street 1:826 CAMINO DE MONTE REY STE A2
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3961
Practice Address - Country:US
Practice Address - Phone:505-670-1841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM363171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist