Healthcare Provider Details

I. General information

NPI: 1316781586
Provider Name (Legal Business Name): ROMARO WALTERS SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2024
Last Update Date: 06/22/2024
Certification Date: 06/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3983 E 121ST ST
CLEVELAND OH
44105-4572
US

IV. Provider business mailing address

3983 E 121ST ST
CLEVELAND OH
44105-4572
US

V. Phone/Fax

Practice location:
  • Phone: 216-334-9947
  • Fax:
Mailing address:
  • Phone: 216-334-9947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: