Provider Demographics
NPI:1881949790
Name:ROMERO TOSADO, JEY
Entity type:Individual
Prefix:
First Name:JEY
Middle Name:
Last Name:ROMERO TOSADO
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:PO BOX 620
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-0620
Mailing Address - Country:US
Mailing Address - Phone:787-313-8344
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 42.5
Practice Address - Street 2:BO ALGARROBO
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00694
Practice Address - Country:US
Practice Address - Phone:787-313-8344
Practice Address - Fax:787-621-4025
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4334103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4292902OtherDRIVER'S LICENSE