Provider Demographics
NPI:1851524961
Name:ROMERO, MIRIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 W 41ST PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-2118
Mailing Address - Country:US
Mailing Address - Phone:323-829-9751
Mailing Address - Fax:
Practice Address - Street 1:8914 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-4834
Practice Address - Country:US
Practice Address - Phone:323-750-3370
Practice Address - Fax:323-750-2485
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA585651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice