MEDICARE: EDWARD ROMO L.AC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	11855	CA

General Provider Information

NPI Number	:	1285863472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD ROMO L.AC

Provider Business Mailing Address
First Line	:	2041 E IDAHOME ST
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91791-1412
Country	:	US
Telephone Number	:	909-264-0185
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 BROOKSIDE AVE STE 105
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92373-5189
Country	:	US
Telephone Number	:	909-264-0185
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2009
Last Update Date	:	07/08/2009

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Directions to “ EDWARD ROMO L.AC” Practice Location

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