Provider Demographics
NPI:1881365740
Name:ROMERO, BRENDA MICHELLE
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:MICHELLE
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 1:1000 S FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-8800
Mailing Address - Country:US
Mailing Address - Phone:626-349-3838
Mailing Address - Fax:626-737-1095
Practice Address - Street 1:13920 CITY CENTER DR STE 290
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5444
Practice Address - Country:US
Practice Address - Phone:866-351-8887
Practice Address - Fax:626-737-1095
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty