Provider Demographics
NPI:1700124609
Name:ROMERO, LUIS MEGUAL (SA-C)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:MEGUAL
Last Name:ROMERO
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 GROVETHORN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-4906
Mailing Address - Country:US
Mailing Address - Phone:443-600-3660
Mailing Address - Fax:
Practice Address - Street 1:522 GROVETHORN RD
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-4906
Practice Address - Country:US
Practice Address - Phone:443-600-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06-159246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant