Healthcare Provider Details

I. General information

NPI: 1942361548
Provider Name (Legal Business Name): ELIOTT ROMERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N TUSTIN AVE SUITE 220
SANTA ANA CA
92705-3528
US

IV. Provider business mailing address

999 N TUSTIN AVE SUITE 220
SANTA ANA CA
92705-3528
US

V. Phone/Fax

Practice location:
  • Phone: 714-543-3522
  • Fax: 714-543-3267
Mailing address:
  • Phone: 714-543-3522
  • Fax: 714-543-3267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG48383
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberG48383
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: