Organization
LDR MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA DIANE ROMERO FNP-C (NURSE PRACTITIONER, BUSINESS OWNER)
(928) 289-6093
Entity
Organization
Contact information
Practice address
305 W SECOND ST, WINSLOW, AZ 86047-3406
(928) 289-6093
(928) 289-6787
Mailing address
305 W SECOND ST, WINSLOW, AZ 86047-3406
(928) 289-6093
(928) 289-6787
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
AP3306
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255575411
—
AZ
Enumeration date
12/06/2017
Last updated
06/16/2018
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