Provider Demographics
NPI:1144308867
Name:ROMERO, MARY-BARBARA (MD)
Entity type:Individual
Prefix:
First Name:MARY-BARBARA
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY-BARBARA
Other - Middle Name:
Other - Last Name:CRAVEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1600 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3027
Mailing Address - Country:US
Mailing Address - Phone:916-746-3590
Mailing Address - Fax:
Practice Address - Street 1:1600 EUREKA RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3027
Practice Address - Country:US
Practice Address - Phone:916-746-3590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H09207Medicare UPIN
CA00A634950Medicaid
00A634950Medicare ID - Type Unspecified