Provider Demographics
NPI:1861761363
Name:ROMERO, CHRISTINA (TX CERTIFIED TEACHER)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:TX CERTIFIED TEACHER
Other - Prefix:
Other - First Name:VOICE
Other - Middle Name:
Other - Last Name:BOUTIQUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TX BOARD CERTIFIED
Mailing Address - Street 1:PO BOX 49503
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78765-9503
Mailing Address - Country:US
Mailing Address - Phone:512-968-3387
Mailing Address - Fax:
Practice Address - Street 1:5711 AVE G
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-4509
Practice Address - Country:US
Practice Address - Phone:512-968-3387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXEOMedicaid
TX46Medicaid