Provider Demographics
NPI:1376369546
Name:ROMO, MAIRA
Entity type:Individual
Prefix:
First Name:MAIRA
Middle Name:
Last Name:ROMO
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 1:755 SEQUOIA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:CA
Mailing Address - Zip Code:93247-1422
Mailing Address - Country:US
Mailing Address - Phone:559-562-1100
Mailing Address - Fax:
Practice Address - Street 1:755 SEQUOIA AVE STE A
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:CA
Practice Address - Zip Code:93247-1422
Practice Address - Country:US
Practice Address - Phone:559-562-1100
Practice Address - Fax:559-562-1699
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37071124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist