MEDICARE: RAFAEL ROMERO CSFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1073997425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAEL ROMERO CSFA

Provider Business Mailing Address
First Line	:	3770 SEVEN SEAS AVE
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-2906
Country	:	US
Telephone Number	:	727-375-7091
Fax Number	:

Provider Business Practice Location Address
First Line	:	3770 SEVEN SEAS AVE
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-2906
Country	:	US
Telephone Number	:	727-375-7091
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2015
Last Update Date	:	07/15/2015

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