=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790839124
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DORIS RUTH ROMERO D.O.M.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2007
-----------------------------------------------------
Last Update Date | 04/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 826 CAMINO DE MONTE REY STE A3
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87505-3961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-670-1841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 406 GOLDMINE RD
-----------------------------------------------------
City | CERRILLOS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87010-9717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-670-1841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 363
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------