Healthcare Provider Details

I. General information

NPI: 1841463353
Provider Name (Legal Business Name): ELIOTT ROMERO, MD CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57340 29 PALMS HWY
YUCCA VALLEY CA
92284-2927
US

IV. Provider business mailing address

57340 29 PALMS HWY
YUCCA VALLEY CA
92284-2927
US

V. Phone/Fax

Practice location:
  • Phone: 760-365-2308
  • Fax: 760-365-7538
Mailing address:
  • Phone: 760-365-2308
  • Fax: 760-365-7538

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: ELIOTT ROMERO
Title or Position: PROPRIETOR
Credential: M.D.
Phone: 760-365-2308