Provider Demographics
NPI:1750143947
Name:ROMO-DANIEL, DESTYNEE
Entity type:Individual
Prefix:
First Name:DESTYNEE
Middle Name:
Last Name:ROMO-DANIEL
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 1:3220 W INA RD APT 10108
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2167
Mailing Address - Country:US
Mailing Address - Phone:520-827-1081
Mailing Address - Fax:
Practice Address - Street 1:3220 W INA RD APT 10108
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2167
Practice Address - Country:US
Practice Address - Phone:520-827-1081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ277832376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty