Provider Demographics
NPI:1588989248
Name:ROMERO PADILLA, FEDELINA DOLORES (LSAA)
Entity type:Individual
Prefix:
First Name:FEDELINA
Middle Name:DOLORES
Last Name:ROMERO PADILLA
Suffix:
Gender:F
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 807
Mailing Address - Street 2:
Mailing Address - City:ESTANCIA
Mailing Address - State:NM
Mailing Address - Zip Code:87016-0164
Mailing Address - Country:US
Mailing Address - Phone:505-384-2777
Mailing Address - Fax:505-384-2204
Practice Address - Street 1:903 C 5TH STREET
Practice Address - Street 2:
Practice Address - City:ESTANCIA
Practice Address - State:NM
Practice Address - Zip Code:87016-0164
Practice Address - Country:US
Practice Address - Phone:505-384-2777
Practice Address - Fax:505-384-2204
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0098531101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health