Provider Demographics
NPI:1063096410
Name:ROMERO, JEFFREY PAUL (MS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PAUL
Last Name:ROMERO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 S CHEVY CHASE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1326
Mailing Address - Country:US
Mailing Address - Phone:818-275-9676
Mailing Address - Fax:
Practice Address - Street 1:TAINE 216
Practice Address - Street 2:
Practice Address - City:MEXICO CITY
Practice Address - State:MEXICO CITY
Practice Address - Zip Code:11560
Practice Address - Country:MX
Practice Address - Phone:553-687-7141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101Y00000XBehavioral Health & Social Service ProvidersCounselor