Provider Demographics
NPI:1942361548
Name:ROMERO, ELIOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIOTT
Middle Name:
Last Name:ROMERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 N TUSTIN AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3528
Mailing Address - Country:US
Mailing Address - Phone:714-543-3522
Mailing Address - Fax:714-543-3267
Practice Address - Street 1:999 N TUSTIN AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3528
Practice Address - Country:US
Practice Address - Phone:714-543-3522
Practice Address - Fax:714-543-3267
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48383207Q00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1841463353OtherSUBPART
CA1841463353Medicaid
CA00G483831Medicaid
CA1942361548OtherMEDICARE
CA1841463353OtherSUBPART
CA1942361548OtherMEDICARE