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Individual

DOMINIC XAVIER ROMERO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
318 S 6TH AVE, POCATELLO, ID 83201-5809
(575) 993-2495
Mailing address
318 S 6TH AVE, POCATELLO, ID 83201-5809
(575) 993-2495

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0002673011
ID
Enumeration date
08/22/2022
Last updated
08/30/2024
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