Provider Demographics
NPI:1902164106
Name:ROMERO, MA. ELOISA VIDANES (FNP)
Entity Type:Individual
Prefix:
First Name:MA. ELOISA
Middle Name:VIDANES
Last Name:ROMERO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22003 S VERMONT AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2122
Mailing Address - Country:US
Mailing Address - Phone:424-270-4371
Mailing Address - Fax:
Practice Address - Street 1:22003 S VERMONT AVE APT 11
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2122
Practice Address - Country:US
Practice Address - Phone:424-270-4371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily