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General NPI Number Information
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NPI Number | 1356180384
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Entity Type | Individual
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Provider Name | LIDIA ROMERO LSAA
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Gender | Female
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | PO BOX 292
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City | TOME
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State | NM
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Zip | 87060-0292
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Country | US
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Telephone | 505-312-0040
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Fax |
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Provider Business Mailing Address
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Address Line | 838 W DIDIER AVE
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City | BELEN
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State | NM
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Zip | 87002-3160
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Country | US
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Telephone | 575-835-4357
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Fax | 505-514-0732
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CTB-2024-0713
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License Number State | NM
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