Provider Demographics
NPI:1528770526
Name:ROMERO, PEDRO ALEXIS
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:ALEXIS
Last Name:ROMERO
Suffix:
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 1:837 E ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2587
Mailing Address - Country:US
Mailing Address - Phone:909-621-9052
Mailing Address - Fax:
Practice Address - Street 1:837 E ARROW HWY
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2587
Practice Address - Country:US
Practice Address - Phone:909-621-9052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0000000000Medicaid
CA00000000000000000000OtherPROTOTYPES
CA0000000000OtherPROTOTYPES