Provider Demographics
NPI:1114032208
Name:JESUSA N ROMERO MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JESUSA N ROMERO MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:JESUSA
Authorized Official - Middle Name:NAVARRO
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-804-5295
Mailing Address - Street 1:9321 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3508
Mailing Address - Country:US
Mailing Address - Phone:562-804-5295
Mailing Address - Fax:
Practice Address - Street 1:10230 ARTESIA BLVD
Practice Address - Street 2:STE 209
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-6763
Practice Address - Country:US
Practice Address - Phone:562-804-5295
Practice Address - Fax:562-504-5296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34299207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA34299OtherMEDICAL LICENSE
CA00A342991Medicaid
CA05D0705610OtherCLIA