Provider Demographics
NPI:1124663976
Name:ROMERO, MONICA LAVELLE
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:LAVELLE
Last Name:ROMERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35711 MOUNTAIN HWY E
Mailing Address - Street 2:
Mailing Address - City:EATONVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98328-9232
Mailing Address - Country:US
Mailing Address - Phone:831-291-8149
Mailing Address - Fax:
Practice Address - Street 1:35711 MOUNTAIN HWY E # 35
Practice Address - Street 2:
Practice Address - City:EATONVILLE
Practice Address - State:WA
Practice Address - Zip Code:98328-9232
Practice Address - Country:US
Practice Address - Phone:831-291-8149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist