Healthcare Provider Details

I. General information

NPI: 1619575412
Provider Name (Legal Business Name): GENESIS GEORGINA ROMERO CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4626 E FORT LOWELL RD STE N
TUCSON AZ
85712-1182
US

IV. Provider business mailing address

2379 W OWL PERCH LOOP
TUCSON AZ
85745-0041
US

V. Phone/Fax

Practice location:
  • Phone: 602-892-9944
  • Fax:
Mailing address:
  • Phone: 602-580-8232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP12426
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: