Provider Demographics
NPI:1134740673
Name:ROMO RODRIGUEZ, JOHANNA C (MD)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:C
Last Name:ROMO RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVENUE - LM068
Mailing Address - Street 2:UCONN SCHOOL OF MEDICINE - GRADUATE MEDICAL EDUCATION
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-1921
Mailing Address - Country:US
Mailing Address - Phone:860-679-2147
Mailing Address - Fax:860-679-4624
Practice Address - Street 1:100 GRAND STREET
Practice Address - Street 2:HOSPITAL OF CENTRAL CONNECTICUT OUTPATIENT CLINIC
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052
Practice Address - Country:US
Practice Address - Phone:860-224-5261
Practice Address - Fax:860-224-5957
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program