Provider Demographics
NPI:1649009382
Name:ROMERO, MIA AILICEC
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:AILICEC
Last Name:ROMERO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 W BRIGHTON AVE APT A
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3127
Mailing Address - Country:US
Mailing Address - Phone:442-230-7249
Mailing Address - Fax:
Practice Address - Street 1:532 W BRIGHTON AVE APT A
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3127
Practice Address - Country:US
Practice Address - Phone:442-230-7249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-25-418500106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician