Provider Demographics
NPI:1053994962
Name:ROMERO, ESTEVAN ANTONIO
Entity type:Individual
Prefix:
First Name:ESTEVAN
Middle Name:ANTONIO
Last Name:ROMERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:SPRINGER
Mailing Address - State:NM
Mailing Address - Zip Code:87747-0446
Mailing Address - Country:US
Mailing Address - Phone:505-398-1567
Mailing Address - Fax:575-383-3337
Practice Address - Street 1:802 3RD STREET
Practice Address - Street 2:
Practice Address - City:SPRINGER
Practice Address - State:NM
Practice Address - Zip Code:87747
Practice Address - Country:US
Practice Address - Phone:505-398-1567
Practice Address - Fax:575-383-3337
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical