Provider Demographics
NPI:1649099821
Name:ROMERO EFIGENIO, SALLY
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:ROMERO EFIGENIO
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 1:16321 YORBA LINDA
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5672
Mailing Address - Country:US
Mailing Address - Phone:213-327-4260
Mailing Address - Fax:
Practice Address - Street 1:16321 YORBA LINDA
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-5672
Practice Address - Country:US
Practice Address - Phone:213-327-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician