Provider Demographics
NPI:1992283964
Name:ROMERO, LIDIA (AU,D)
Entity type:Individual
Prefix:
First Name:LIDIA
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:AU,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8263 GROVE AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3107
Mailing Address - Country:US
Mailing Address - Phone:909-920-9906
Mailing Address - Fax:909-920-4151
Practice Address - Street 1:711 W CAMINO REAL AVE STE 202
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9326
Practice Address - Country:US
Practice Address - Phone:626-574-0437
Practice Address - Fax:626-574-2902
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA8150231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1164559456Medicaid