Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0210X | Pediatric Nephrologist | 4301097904 | MI |
Y | 2080P0210X | Pediatric Nephrologist | S4378 | TX |
NPI | 1871871616 |
---|---|
Provider Name | Mauricio Romero Olvera |
First Address | Corpus Christi, TX 78411-1721 |
Second Address | Corpus Christi, TX 78411-1721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2011 |
Last Update Date | 21/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
408082201 | (05) | TX |