Provider Demographics
NPI:1902112956
Name:ROMERO FAMILY MEDICINE,LLC
Entity Type:Organization
Organization Name:ROMERO FAMILY MEDICINE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:LIZA
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-924-1895
Mailing Address - Street 1:4600 JEFFERSON LN NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2134
Mailing Address - Country:US
Mailing Address - Phone:505-881-1229
Mailing Address - Fax:055-888-1918
Practice Address - Street 1:4600 JEFFERSON LN NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2134
Practice Address - Country:US
Practice Address - Phone:505-924-1895
Practice Address - Fax:505-792-1890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03195795001261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM33577889Medicaid
NM33577889Medicaid