Healthcare Provider Details

I. General information

NPI: 1053765511
Provider Name (Legal Business Name): LINDA ROMERO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARQUETTE AVE NW SUITE 1200
ALBUQUERQUE NM
87102-5340
US

IV. Provider business mailing address

500 MARQUETTE AVE NW SUITE 1200
ALBUQUERQUE NM
87102-5340
US

V. Phone/Fax

Practice location:
  • Phone: 505-385-5350
  • Fax: 505-213-7783
Mailing address:
  • Phone: 505-385-5350
  • Fax: 505-213-7783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNM

VIII. Authorized Official

Name: LINDA ROMERO
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 505-385-5350