Healthcare Provider Details

I. General information

NPI: 1275867731
Provider Name (Legal Business Name): KRISTIN ROMERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 S 3RD ST
SANTA ROSA NM
88435-2411
US

IV. Provider business mailing address

344 S 4TH ST
SANTA ROSA NM
88435-2325
US

V. Phone/Fax

Practice location:
  • Phone: 575-472-3422
  • Fax:
Mailing address:
  • Phone: 575-472-3171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: