Provider Demographics
NPI:1700410453
Name:ROMERO, ALIYAH
Entity Type:Individual
Prefix:
First Name:ALIYAH
Middle Name:
Last Name:ROMERO
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 1:13 LOWER FIREHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-9415
Mailing Address - Country:US
Mailing Address - Phone:505-484-5787
Mailing Address - Fax:
Practice Address - Street 1:1227 N RAILROAD AVE STE C
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3159
Practice Address - Country:US
Practice Address - Phone:505-747-8187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM59555164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse