Provider Demographics
NPI:1356869846
Name:LADERO, ROMEO REYES JR (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:ROMEO
Middle Name:REYES
Last Name:LADERO
Suffix:JR
Gender:M
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:38340 INNOVATION CT # D-404
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2621
Mailing Address - Country:US
Mailing Address - Phone:951-721-2768
Mailing Address - Fax:
Practice Address - Street 1:38340 INNOVATION CT # D-404
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2621
Practice Address - Country:US
Practice Address - Phone:951-721-2768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95008999363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1356869846Medicaid