Provider Demographics
NPI:1134252208
Name:ROMINE, MARLENA K (CST)
Entity type:Individual
Prefix:
First Name:MARLENA
Middle Name:K
Last Name:ROMINE
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 COOK HILLS RD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-1145
Mailing Address - Country:US
Mailing Address - Phone:817-426-2874
Mailing Address - Fax:817-295-8891
Practice Address - Street 1:1169 N. BURLESON BLVD.
Practice Address - Street 2:#107-233
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028
Practice Address - Country:US
Practice Address - Phone:817-426-2874
Practice Address - Fax:817-295-8891
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78333246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist