Provider Demographics
NPI:1124203070
Name:ROMERO, JULIAN
Entity Type:Individual
Prefix:MR
First Name:JULIAN
Middle Name:
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:PO BOX 1031
Mailing Address - Street 2:
Mailing Address - City:CAPITAN
Mailing Address - State:NM
Mailing Address - Zip Code:88316-1031
Mailing Address - Country:US
Mailing Address - Phone:575-354-2808
Mailing Address - Fax:
Practice Address - Street 1:249 WHITE MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:MESCALERO
Practice Address - State:NM
Practice Address - Zip Code:88340-9622
Practice Address - Country:US
Practice Address - Phone:575-464-4431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool