Healthcare Provider Details

I. General information

NPI: 1689783201
Provider Name (Legal Business Name): ELIZABETH ANN ROMERO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 JUAN TABO BLVD NE SUITE 105
ALBUQUERQUE NM
87111-2692
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-504-1027
  • Fax:
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2003-0078
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: