Provider Demographics
NPI:1447772710
Name:ROMERO, ENRIQUE FERNANDO
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:FERNANDO
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 1:16519 SW 36TH STREET
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027
Mailing Address - Country:US
Mailing Address - Phone:954-914-1221
Mailing Address - Fax:
Practice Address - Street 1:16519 SW 36TH ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4521
Practice Address - Country:US
Practice Address - Phone:954-914-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLR560206593300106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician