Provider Demographics
NPI:1700879160
Name:ROMERO, XOCHITL (PA-C)
Entity Type:Individual
Prefix:MS
First Name:XOCHITL
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:XOCHITL
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:538 N PASEO DE ONATE
Mailing Address - Street 2:P.O. BOX 158
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2618
Mailing Address - Country:US
Mailing Address - Phone:505-753-7218
Mailing Address - Fax:505-753-5815
Practice Address - Street 1:711 BOND ST
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2729
Practice Address - Country:US
Practice Address - Phone:505-753-9503
Practice Address - Fax:505-747-1004
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM82-PA001363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM91637Medicaid