Provider Demographics
NPI:1649664137
Name:ROMERO, MARLY YVETTE (LVN)
Entity type:Individual
Prefix:MRS
First Name:MARLY
Middle Name:YVETTE
Last Name:ROMERO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MISS
Other - First Name:MARLY
Other - Middle Name:YVETTE
Other - Last Name:BENAVIDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:23119 COTTONWOOD AVE BLDG A STE110
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553
Mailing Address - Country:US
Mailing Address - Phone:951-413-5678
Mailing Address - Fax:951-413-5660
Practice Address - Street 1:23119 COTTONWOOD AVE STE 110
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-9661
Practice Address - Country:US
Practice Address - Phone:951-413-5678
Practice Address - Fax:951-413-5660
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA273125164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse