Provider Demographics
NPI:1417618661
Name:ROMERO LEON, ESPERANZO
Entity Type:Individual
Prefix:
First Name:ESPERANZO
Middle Name:
Last Name:ROMERO LEON
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 1:2131 MARS CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-6830
Mailing Address - Country:US
Mailing Address - Phone:661-633-1700
Mailing Address - Fax:
Practice Address - Street 1:4101 EASTON DRIVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309
Practice Address - Country:US
Practice Address - Phone:661-633-1700
Practice Address - Fax:661-633-1785
Is Sole Proprietor?:No
Enumeration Date:2022-01-09
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA102433104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health