Provider Demographics
NPI:1689927220
Name:ROMERO, CARLOS ANGEL (PA)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:ANGEL
Last Name:ROMERO
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5564 E GRANT ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-1666
Mailing Address - Country:US
Mailing Address - Phone:321-235-6230
Mailing Address - Fax:321-235-6246
Practice Address - Street 1:8000 RED BUG LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9265
Practice Address - Country:US
Practice Address - Phone:407-366-6004
Practice Address - Fax:407-366-6919
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106927363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant