Healthcare Provider Details

I. General information

NPI: 1669476461
Provider Name (Legal Business Name): HAROLD A ROMERO P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 E. CAMP LOWELL DRIVE
TUCSON AZ
85712-1256
US

IV. Provider business mailing address

4727 E CAMP LOWELL DR
TUCSON AZ
85712-1256
US

V. Phone/Fax

Practice location:
  • Phone: 520-290-4263
  • Fax: 520-323-2716
Mailing address:
  • Phone: 520-290-4263
  • Fax: 520-323-2716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2827
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: