Provider Demographics
NPI:1811689029
Name:ROMERO VAZQUEZ, OLGA ADRIANA
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:ADRIANA
Last Name:ROMERO VAZQUEZ
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 1:8866 LAMAR ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-2647
Mailing Address - Country:US
Mailing Address - Phone:840-900-8509
Mailing Address - Fax:
Practice Address - Street 1:8866 LAMAR ST UNIT 3
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-2647
Practice Address - Country:US
Practice Address - Phone:840-900-8509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral