Healthcare Provider Details

I. General information

NPI: 1417434838
Provider Name (Legal Business Name): TERESA DE JESUS ROMERO RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 EL CAJON BLVD
EL CAJON CA
92020-5703
US

IV. Provider business mailing address

1380 EL CAJON BLVD
EL CAJON CA
92020-5703
US

V. Phone/Fax

Practice location:
  • Phone: 858-499-2700
  • Fax:
Mailing address:
  • Phone: 858-499-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number659512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: