Healthcare Provider Details

I. General information

NPI: 1669109815
Provider Name (Legal Business Name): CALVIN ROMERO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SE
ALBUQUERQUE NM
87106-4930
US

IV. Provider business mailing address

7205 SACATE ALTO ST NW
ALBUQUERQUE NM
87120-1554
US

V. Phone/Fax

Practice location:
  • Phone: 505-780-4709
  • Fax:
Mailing address:
  • Phone: 505-780-4709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2024-0062
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: