Basic Information
| Provider Information | |||||||||
| NPI: | 1851933139 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROMERO | ||||||||
| FirstName: | TRACY | ||||||||
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| Credential: | CPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9840 NE 190TH ST APT G301 | ||||||||
| Address2: | |||||||||
| City: | BOTHELL | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980112976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064886399 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1210 SW 136TH ST | ||||||||
| Address2: | |||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981661214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062576600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2019 | ||||||||
| LastUpdateDate: | 10/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | WA | Y |
No ID Information.