Provider Demographics
NPI:1003617390
Name:ROMERO, RENITA ROCHELLE (FNP)
Entity type:Individual
Prefix:
First Name:RENITA
Middle Name:ROCHELLE
Last Name:ROMERO
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30066 FLORAL GRV
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-2593
Mailing Address - Country:US
Mailing Address - Phone:760-668-0121
Mailing Address - Fax:
Practice Address - Street 1:600 E TAHQUITZ CANYON WAY STE 3
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6721
Practice Address - Country:US
Practice Address - Phone:760-325-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily