Provider Demographics
NPI:1073885356
Name:ROMERO, ALFONSO JOE JR (LAC)
Entity Type:Individual
Prefix:MR
First Name:ALFONSO
Middle Name:JOE
Last Name:ROMERO
Suffix:JR
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:32222 SEA RAVEN DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-6117
Mailing Address - Country:US
Mailing Address - Phone:562-673-9522
Mailing Address - Fax:
Practice Address - Street 1:8727 LA TIJERA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3906
Practice Address - Country:US
Practice Address - Phone:855-372-3717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9554171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist