Provider Demographics
NPI:1487270518
Name:GABASAN, ROMEO ONG JR
Entity type:Individual
Prefix:
First Name:ROMEO
Middle Name:ONG
Last Name:GABASAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10717 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-2359
Mailing Address - Country:US
Mailing Address - Phone:760-628-7568
Mailing Address - Fax:
Practice Address - Street 1:5770 RIVERSIDE DR., BLDG 601
Practice Address - Street 2:752 MEDICAL SQUADRON
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:92518
Practice Address - Country:US
Practice Address - Phone:951-655-5167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA836405163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice