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NPI Code Detail

MEDICARE: BRISEIDA ROMERO ALEJANDRE

MEDICARE: BRISEIDA ROMERO ALEJANDRE
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
1363A00000XPhysician Assistant52317CA
2363A00000XPhysician AssistantPA.0004916CO

General Provider Information

NPI Number : 1710371604
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRISEIDA ROMERO ALEJANDRE
Provider Business Mailing Address
First Line : 559 VINCENT ST
Second Line : ATTN: 21 MDOS/SGOF- FAMILY MEDICINE
City : PETERSON AFB
State : CO
Zip : 80914-1540
Country : US
Telephone Number : 719-567-4162
Fax Number :
Provider Business Practice Location Address
First Line : 1338 PHAY AVE
Second Line :
City : CANON CITY
State : CO
Zip : 81212-2311
Country : US
Telephone Number : 719-285-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2015
Last Update Date : 09/12/2023

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Directions to “ BRISEIDA ROMERO ALEJANDRE ” Practice Location

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