Provider Demographics
NPI:1649770579
Name:ROMERO-VIGUERIAS, SANDRA ISABEL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ISABEL
Last Name:ROMERO-VIGUERIAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:ISABEL
Other - Last Name:VIGUERIAS GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3102 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PATTON
Mailing Address - State:CA
Mailing Address - Zip Code:92369-7813
Mailing Address - Country:US
Mailing Address - Phone:909-425-7000
Mailing Address - Fax:
Practice Address - Street 1:3102 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PATTON
Practice Address - State:CA
Practice Address - Zip Code:92369-7813
Practice Address - Country:US
Practice Address - Phone:909-425-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2023-06-28
Deactivation Date:2021-01-08
Deactivation Code:
Reactivation Date:2021-03-11
Provider Licenses
StateLicense IDTaxonomies
CARBT-17-45069106S00000X
CA1154011041C0700X
CA94072101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health