Provider Demographics
NPI:1639235831
Name:MARIANO, ROMEO BLAS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMEO
Middle Name:BLAS
Last Name:MARIANO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:225 CROSSROADS BLVD
Mailing Address - Street 2:PMB 416
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8674
Mailing Address - Country:US
Mailing Address - Phone:831-375-6655
Mailing Address - Fax:
Practice Address - Street 1:262 EL DORADO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2915
Practice Address - Country:US
Practice Address - Phone:831-375-6655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG736922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG73692OtherMEDICAL LICENSE
CABM3110082OtherDEA NUMBER
CAG73692OtherMEDICAL LICENSE