Provider Demographics
NPI:1962104968
Name:ROMERO, IRENE MARIE
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:MARIE
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 1:199 N FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-2304
Mailing Address - Country:US
Mailing Address - Phone:805-964-9892
Mailing Address - Fax:
Practice Address - Street 1:199 N FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-2304
Practice Address - Country:US
Practice Address - Phone:805-964-9892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA130216183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician