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General NPI Number Information
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NPI Number | 1427673656
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Entity Type | Individual
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Provider Name | MICHAEL DAVID ROMERO
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Gender | Male
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Dates
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Enumeration Date | 06/12/2020
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 100 ROWLAND WAY STE 300
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City | NOVATO
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State | CA
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Zip | 94945-5041
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Country | US
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Telephone | 415-878-0225
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Fax | 415-878-0215
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Provider Business Mailing Address
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Address Line | 1055 N 500 W
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City | PROVO
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State | UT
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Zip | 84604-3305
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Country | US
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Telephone | 801-354-8225
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Fax | 801-418-0941
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 64228
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License Number State | CA
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