=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942645866
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELIZABETH A. ROMERO, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2013
-----------------------------------------------------
Last Update Date | 05/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5100 JUAN TABO BLVD NE SUITE 105
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87111-2692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-504-1027
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5100 JUAN TABO BLVD NE SUITE 105
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87111-2692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-504-1027
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | JUDE CIDDIO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 505-504-1027
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | NM20030078
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------