Healthcare Provider Details

I. General information

NPI: 1023653094
Provider Name (Legal Business Name): ROMANELLI IME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 N SONOMA RANCH BLVD STE 2
LAS CRUCES NM
88011-7334
US

IV. Provider business mailing address

2001 E LOHMAN AVE STE 110-284
LAS CRUCES NM
88001-3167
US

V. Phone/Fax

Practice location:
  • Phone: 575-652-3528
  • Fax: 572-652-3389
Mailing address:
  • Phone: 575-652-3528
  • Fax: 575-652-3389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL ROMANELLI
Title or Position: MEMBER
Credential: MD
Phone: 575-652-3528