Healthcare Provider Details

I. General information

NPI: 1720834807
Provider Name (Legal Business Name): MR. MARK DAVID ROMERO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77A FEATHER CATCHER
SANTA FE NM
87506-2699
US

IV. Provider business mailing address

77A FEATHER CATCHER
SANTA FE NM
87506-2699
US

V. Phone/Fax

Practice location:
  • Phone: 505-692-3980
  • Fax:
Mailing address:
  • Phone: 505-692-3980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: