Provider Demographics
NPI:1104408277
Name:ROMANO, RAFAEL LEOPOLDO
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:LEOPOLDO
Last Name:ROMANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9480 GRACEFUL GOLD ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-3889
Mailing Address - Country:US
Mailing Address - Phone:702-969-9849
Mailing Address - Fax:
Practice Address - Street 1:9480 GRACEFUL GOLD ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-3889
Practice Address - Country:US
Practice Address - Phone:702-969-9849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner