Provider Demographics
NPI:1770123911
Name:ROMERO, RAUL
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:ROMERO
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 1:9840 PALMETTO CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1731
Mailing Address - Country:US
Mailing Address - Phone:772-404-8266
Mailing Address - Fax:
Practice Address - Street 1:9840 PALMETTO CLUB DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1731
Practice Address - Country:US
Practice Address - Phone:772-404-8266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst