Basic Information
| Provider Information | |||||||||
| NPI: | 1912295445 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROMERO | ||||||||
| FirstName: | FABIAN | ||||||||
| MiddleName: | ANDRES | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4922 LASALLE RD | ||||||||
| Address2: | |||||||||
| City: | HYATTSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207823302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012776310 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1301 20TH ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104530419 | ||||||||
| FaxNumber: | 3108291960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2011 | ||||||||
| LastUpdateDate: | 08/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D81370 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | D0081370 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RI0200X | A162848 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.