Healthcare Provider Details

I. General information

NPI: 1720914401
Provider Name (Legal Business Name): VANESSA CRYSTAL ROMO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MEDITERRANEAN PALM DR
RIO GRANDE CITY TX
78582-6408
US

IV. Provider business mailing address

104 MEDITERRANEAN PALM DR
RIO GRANDE CITY TX
78582-6408
US

V. Phone/Fax

Practice location:
  • Phone: 956-437-1715
  • Fax:
Mailing address:
  • Phone: 956-437-1715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number906607
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: