Provider Demographics
NPI:1225813827
Name:ROMERO SIMO, ANGELO JOSE (RBT)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:JOSE
Last Name:ROMERO SIMO
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24634 SW 115TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4712
Mailing Address - Country:US
Mailing Address - Phone:305-457-5467
Mailing Address - Fax:
Practice Address - Street 1:24634 SW 115TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-4712
Practice Address - Country:US
Practice Address - Phone:305-457-5467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-143203106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty