Basic Information
| Provider Information | |||||||||
| NPI: | 1003128075 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROMERO-JARAMILLO | ||||||||
| FirstName: | BERNADETTE | ||||||||
| MiddleName: | JESSICA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 706 D LA JOYA STREET | ||||||||
| Address2: | |||||||||
| City: | ESPANOLA | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057536550 | ||||||||
| FaxNumber: | 5057531219 | ||||||||
| Practice Location | |||||||||
| Address1: | 706 D LA JOYA STREET | ||||||||
| Address2: | |||||||||
| City: | ESPANOLA | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057536550 | ||||||||
| FaxNumber: | 5057531219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2010 | ||||||||
| LastUpdateDate: | 07/07/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | 3680 | NM | Y | Other Service Providers | Community Health Worker |
No ID Information.