Provider Demographics
NPI:1790442903
Name:ROMO, JUSTIN ANGEL
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ANGEL
Last Name:ROMO
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 1:26013 CHLOE PL
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-5907
Mailing Address - Country:US
Mailing Address - Phone:760-539-9495
Mailing Address - Fax:
Practice Address - Street 1:26013 CHLOE PL
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-5907
Practice Address - Country:US
Practice Address - Phone:760-539-9495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician