Healthcare Provider Details

I. General information

NPI: 1376369546
Provider Name (Legal Business Name): MAIRA ROMO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 SEQUOIA AVE STE A
LINDSAY CA
93247-1422
US

IV. Provider business mailing address

755 SEQUOIA AVE STE A
LINDSAY CA
93247-1422
US

V. Phone/Fax

Practice location:
  • Phone: 559-562-1100
  • Fax: 559-562-1699
Mailing address:
  • Phone: 559-562-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number37071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: