MEDICARE: MR. ADONAI ONE ROMERO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1407704406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ADONAI ONE ROMERO

Provider Business Mailing Address
First Line	:	PO BOX 224
Second Line	:
City	:	CEDAR CREST
State	:	NM
Zip	:	87008-0224
Country	:	US
Telephone Number	:	505-595-6083
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 SANDIA HAVEN DR
Second Line	:
City	:	CEDAR CREST
State	:	NM
Zip	:	87008-9425
Country	:	US
Telephone Number	:	505-595-6083
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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Directions to “ MR. ADONAI ONE ROMERO ” Practice Location

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