Provider Demographics
NPI:1013324581
Name:PENAFLOR, ROMEO JR
Entity Type:Individual
Prefix:MR
First Name:ROMEO
Middle Name:
Last Name:PENAFLOR
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ROMEO
Other - Middle Name:J
Other - Last Name:PENAFLOR
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:25706 CANYON CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-5290
Mailing Address - Country:US
Mailing Address - Phone:727-348-9613
Mailing Address - Fax:
Practice Address - Street 1:12141 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082
Practice Address - Country:US
Practice Address - Phone:281-588-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily