Provider Demographics
NPI:1821312877
Name:ROMERO, BERTHA
Entity Type:Individual
Prefix:
First Name:BERTHA
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 1:7315 W JONES AVE
Mailing Address - Street 2:
Mailing Address - City:PHX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043
Mailing Address - Country:US
Mailing Address - Phone:602-575-9700
Mailing Address - Fax:
Practice Address - Street 1:7315 W JONES AVE
Practice Address - Street 2:
Practice Address - City:PHX
Practice Address - State:AZ
Practice Address - Zip Code:85043
Practice Address - Country:US
Practice Address - Phone:602-575-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ171MOOOOOX171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator