Provider Demographics
NPI:1558945766
Name:ROMERO JARACUARO, ANAYELI
Entity Type:Individual
Prefix:
First Name:ANAYELI
Middle Name:
Last Name:ROMERO JARACUARO
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 1:2329 W LA VERNE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-3511
Mailing Address - Country:US
Mailing Address - Phone:657-431-9628
Mailing Address - Fax:
Practice Address - Street 1:1901 CARNEGIE AVE STE 1A
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5504
Practice Address - Country:US
Practice Address - Phone:657-431-9629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician