Basic Information
| Provider Information | |||||||||
| NPI: | 1598496903 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROMERO-HERNANDEZ | ||||||||
| FirstName: | GENESIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 NE LOOP 820 STE 200 | ||||||||
| Address2: | |||||||||
| City: | HURST | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760537211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172928787 | ||||||||
| FaxNumber: | 8177896849 | ||||||||
| Practice Location | |||||||||
| Address1: | 6601 MONTANA AVE | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799252155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9158387604 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2022 | ||||||||
| LastUpdateDate: | 06/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 119623 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.