Provider Demographics
NPI:1952080624
Name:ROMERO, JOSE LUIS (NP)
Entity Type:Individual
Prefix:MR
First Name:JOSE LUIS
Middle Name:
Last Name:ROMERO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1146 FAIRFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:HEBER
Mailing Address - State:CA
Mailing Address - Zip Code:92249-9512
Mailing Address - Country:US
Mailing Address - Phone:760-562-9326
Mailing Address - Fax:
Practice Address - Street 1:1146 FAIRFIELD WAY
Practice Address - Street 2:
Practice Address - City:HEBER
Practice Address - State:CA
Practice Address - Zip Code:92249-9512
Practice Address - Country:US
Practice Address - Phone:760-562-9326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily