Provider Demographics
NPI:1952112542
Name:ORTEGA GOMERO, ROMMY BRIAM
Entity type:Individual
Prefix:DR
First Name:ROMMY
Middle Name:BRIAM
Last Name:ORTEGA GOMERO
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 1:26527 MOUNTAINGATE ST
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92585-3231
Mailing Address - Country:US
Mailing Address - Phone:714-454-2196
Mailing Address - Fax:
Practice Address - Street 1:12716 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3510
Practice Address - Country:US
Practice Address - Phone:909-628-5133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1111851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice