Healthcare Provider Details

I. General information

NPI: 1306070941
Provider Name (Legal Business Name): MICHAEL LEE ROMINGER CFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 JOURNAL CENTER BLVD NE
ALBUQUERQUE NM
87109-5900
US

IV. Provider business mailing address

5515 DARLINGTON PL NW
ALBUQUERQUE NM
87114-1358
US

V. Phone/Fax

Practice location:
  • Phone: 505-342-8400
  • Fax:
Mailing address:
  • Phone: 505-401-2272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number114234
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: