Provider Demographics
NPI:1740451095
Name:JESUSA N. ROMERO, MD, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JESUSA N. ROMERO, MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUSA
Authorized Official - Middle Name:NAVARRO
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-584-8818
Mailing Address - Street 1:7136 PACIFIC BLVD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4783
Mailing Address - Country:US
Mailing Address - Phone:323-584-8818
Mailing Address - Fax:
Practice Address - Street 1:9321 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3508
Practice Address - Country:US
Practice Address - Phone:323-584-8818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34299207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A342992Medicaid
CA00A342992Medicaid