Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | AP118518 | TX |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F1009221 | TX |
NPI | 1265769004 |
---|---|
Provider Name | Araceli Romero |
First Address | Odessa, TX 79765-2233 |
Second Address | Odessa, TX 79765-2233 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2009 |
Last Update Date | 14/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
372713301 | (05) | TX |