Provider Demographics
NPI:1922766534
Name:ROMERO, PHOEBE SOLIS
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:SOLIS
Last Name:ROMERO
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 1:1444 CHESTNUT AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-1603
Mailing Address - Country:US
Mailing Address - Phone:310-612-6652
Mailing Address - Fax:
Practice Address - Street 1:2501 W EL SEGUNDO BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3317
Practice Address - Country:US
Practice Address - Phone:323-754-2816
Practice Address - Fax:323-754-2828
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15151-RAC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)