Provider Demographics
NPI:1225607989
Name:ROMERO, JORDAN JAMESEN
Entity Type:Individual
Prefix:MS
First Name:JORDAN
Middle Name:JAMESEN
Last Name:ROMERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11236 DOLPHIN AVE
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-7802
Mailing Address - Country:US
Mailing Address - Phone:951-473-0603
Mailing Address - Fax:
Practice Address - Street 1:11236 DOLPHIN AVE
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-7802
Practice Address - Country:US
Practice Address - Phone:951-473-0603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73338225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist