Basic Information
| Provider Information | |||||||||
| NPI: | 1003171604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROMERO DE MONTERO | ||||||||
| FirstName: | CRISTINA | ||||||||
| MiddleName: | CAROLINA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ROMERO HENRIQUEZ | ||||||||
| OtherFirstName: | CRISTINA | ||||||||
| OtherMiddleName: | CAROLINA | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 30300 CAMINO CAPISTRANO | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN CAPISTRANO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926751304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492402030 | ||||||||
| FaxNumber: | 9492405869 | ||||||||
| Practice Location | |||||||||
| Address1: | 30300 CAMINO CAPISTRANO | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN CAPISTRANO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926751304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492402030 | ||||||||
| FaxNumber: | 9492405869 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2012 | ||||||||
| LastUpdateDate: | 01/30/2017 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A137934 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 265643 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.