Provider Demographics
NPI:1194919431
Name:ROMERO, GLORIA (DC)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15520 ROCKFIELD BLVD
Mailing Address - Street 2:STE A200
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-6705
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:741 W GLADSTONE ST
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-4321
Practice Address - Country:US
Practice Address - Phone:626-653-9222
Practice Address - Fax:626-804-7915
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 30085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA452279192Other1194919431
CADC0300850OtherBLUE SHIELD
CADC30085OtherCHIROPRACTIC LICENSE