Healthcare Provider Details

I. General information

NPI: 1285065334
Provider Name (Legal Business Name): SARAH ROMERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 MCHENRY AVE STE 100
MODESTO CA
95350-4534
US

IV. Provider business mailing address

1691 THE ALAMEDA
SAN JOSE CA
95126-2203
US

V. Phone/Fax

Practice location:
  • Phone: 209-579-2300
  • Fax: 209-579-1948
Mailing address:
  • Phone: 408-795-3619
  • Fax: 408-287-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN831143
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: