Provider Demographics
NPI:1225361272
Name:BARRERA, ROMMEL M
Entity Type:Individual
Prefix:
First Name:ROMMEL
Middle Name:M
Last Name:BARRERA
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 1:1199 PACIFIC HWY UNIT 703
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-8416
Mailing Address - Country:US
Mailing Address - Phone:619-305-6616
Mailing Address - Fax:
Practice Address - Street 1:1202 MORENA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3842
Practice Address - Country:US
Practice Address - Phone:619-275-0822
Practice Address - Fax:619-275-1422
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA617028163WP0809X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult