Healthcare Provider Details

I. General information

NPI: 1215256383
Provider Name (Legal Business Name): CHRISTINE RUTH ROMERO RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE RUTH GIBSON RN, PHN

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4058 WILLOWS RD
ALPINE CA
91901-1668
US

IV. Provider business mailing address

PO BOX 2128
ALPINE CA
91903-2128
US

V. Phone/Fax

Practice location:
  • Phone: 619-445-1188
  • Fax: 619-659-3137
Mailing address:
  • Phone: 619-445-1188
  • Fax: 619-659-3137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number537506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: