Provider Demographics
NPI:1023877412
Name:ROMO PEREZ, TZITZITLINI Y
Entity type:Individual
Prefix:
First Name:TZITZITLINI
Middle Name:Y
Last Name:ROMO PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10012 BEACON AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-2036
Mailing Address - Country:US
Mailing Address - Phone:206-707-3682
Mailing Address - Fax:
Practice Address - Street 1:8801 14TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-4809
Practice Address - Country:US
Practice Address - Phone:206-766-6976
Practice Address - Fax:206-766-6993
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program