Provider Demographics
NPI:1598378259
Name:ROMERO, CARLOS JR
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:ROMERO
Suffix:JR
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 1:20408 S VERMONT AVE UNIT 96
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1530
Mailing Address - Country:US
Mailing Address - Phone:562-533-4821
Mailing Address - Fax:
Practice Address - Street 1:651 W SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-6314
Practice Address - Country:US
Practice Address - Phone:310-507-0021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH82752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist