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General NPI Number Information
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NPI Number | 1285179754
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Entity Type | Organization
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Legal Business Name | BERNADETTE ROUMBOS LLC
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Dates
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Enumeration Date | 12/20/2016
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Last Update Date | 12/20/2016
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Provider Practice Location Address
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Address Line | 2060 W WHISPERING WIND DR #274
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City | PHOENIX
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State | AZ
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Zip | 85085-2867
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Country | US
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Telephone | 602-644-1142
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Fax |
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Provider Business Mailing Address
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Address Line | 120 S HOUGHTON RD SUITE 138-314
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City | TUCSON
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State | AZ
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Zip | 85748-6731
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Country | US
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Telephone | 602-644-1142
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | BERNADETTE ROUMBOS
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Credential | RDN
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Telephone | 590-644-1142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 874789 RDN
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License Number State | AZ
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