Healthcare Provider Details

I. General information

NPI: 1003128075
Provider Name (Legal Business Name): BERNADETTE JESSICA ROMERO-JARAMILLO D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 D LA JOYA STREET
ESPANOLA NM
87532
US

IV. Provider business mailing address

706 D LA JOYA STREET
ESPANOLA NM
87532
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-6550
  • Fax: 505-753-1219
Mailing address:
  • Phone: 505-753-6550
  • Fax: 505-753-1219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number3680
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: