Healthcare Provider Details

I. General information

NPI: 1265487334
Provider Name (Legal Business Name): REY R ROMERO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-2139 FORT WEAVER RD SUITE 300
EWA BEACH HI
96706-3607
US

IV. Provider business mailing address

91-2139 FT WEAVER RD SUITE 300
EWA BEACH HI
96706
US

V. Phone/Fax

Practice location:
  • Phone: 808-680-0558
  • Fax: 808-680-0500
Mailing address:
  • Phone: 808-680-0558
  • Fax: 808-680-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD12702
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: