Provider Demographics
NPI:1871526160
Name:RIEL-ROMERO, ROSARIO MARIA (MD)
Entity type:Individual
Prefix:
First Name:ROSARIO
Middle Name:MARIA
Last Name:RIEL-ROMERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 KINGS HWY
Mailing Address - Street 2:DEPARTMENT OF NEUROLOGY
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4228
Mailing Address - Country:US
Mailing Address - Phone:318-813-2482
Mailing Address - Fax:318-813-2491
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:DEPARTMENT OF NEUROLOGY
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-813-2482
Practice Address - Fax:318-813-2491
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15713R2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1464180Medicaid
LA1464180Medicaid
LAG38288Medicare UPIN