Provider Demographics
NPI:1932285327
Name:ROMERO, ROSALVA (FNP, PA-C)
Entity Type:Individual
Prefix:
First Name:ROSALVA
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:FNP, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 W GONZALES RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-9004
Mailing Address - Country:US
Mailing Address - Phone:805-988-1443
Mailing Address - Fax:805-988-0897
Practice Address - Street 1:451 W GONZALES RD
Practice Address - Street 2:SUITE 230
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-9004
Practice Address - Country:US
Practice Address - Phone:805-988-1443
Practice Address - Fax:805-988-0897
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14038363AM0700X
CA470406363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA470406OtherRN LICENSE NUMBER
CAPA14038OtherPA LICENSE NUMBER