Healthcare Provider Details

I. General information

NPI: 1700905833
Provider Name (Legal Business Name): GUADALUPE JESSICA ROMERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MCHENRY VILLAGE WAY SUITE 11
MODESTO CA
95350-4308
US

IV. Provider business mailing address

PO BOX 3926
TURLOCK CA
95381-3926
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-1440
  • Fax: 209-526-0908
Mailing address:
  • Phone: 209-681-4753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: