Provider Demographics
NPI:1780973446
Name:ROMO, ANTHONY JOHNNY (RAS)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:JOHNNY
Last Name:ROMO
Suffix:
Gender:M
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-5924
Mailing Address - Country:US
Mailing Address - Phone:562-428-4222
Mailing Address - Fax:562-428-0372
Practice Address - Street 1:100 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-5924
Practice Address - Country:US
Practice Address - Phone:562-428-4222
Practice Address - Fax:562-428-0372
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARI-R1101111113OtherBREINING INSTITUTE