Provider Demographics
NPI:1518799147
Name:MARCANO ROMERO, KIMBERLY MADELIZ
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MADELIZ
Last Name:MARCANO 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 1:23414 W FERNHURST DR APT 3104
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-0217
Mailing Address - Country:US
Mailing Address - Phone:787-433-6773
Mailing Address - Fax:
Practice Address - Street 1:1260 PIN OAK RD STE 108
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5603
Practice Address - Country:US
Practice Address - Phone:281-395-5599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist