Provider Demographics
NPI:1316781586
Name:WALTERS, ROMARO SR
Entity type:Individual
Prefix:
First Name:ROMARO
Middle Name:
Last Name:WALTERS
Suffix:SR
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 1:3983 E 121ST ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-4572
Mailing Address - Country:US
Mailing Address - Phone:216-334-9947
Mailing Address - Fax:
Practice Address - Street 1:3983 E 121ST ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-4572
Practice Address - Country:US
Practice Address - Phone:216-334-9947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No172A00000XOther Service ProvidersDriver