Provider Demographics
NPI:1104558378
Name:ROMERO, YADIRA
Entity type:Individual
Prefix:
First Name:YADIRA
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1281 SAN JUAN ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4694
Mailing Address - Country:US
Mailing Address - Phone:951-822-9046
Mailing Address - Fax:
Practice Address - Street 1:2801 BRISTOL ST STE 100
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5996
Practice Address - Country:US
Practice Address - Phone:714-850-8408
Practice Address - Fax:714-850-8587
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health