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NPI Code Detail

MEDICARE: CARLOS V ROMERO CADC L., CPS

MEDICARE: CARLOS V ROMERO CADC L., CPS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor12-03-39OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417353921
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLOS V ROMERO CADC L., CPS
Provider Business Mailing Address
First Line : 6200 SE KING RD
Second Line :
City : PORTLAND
State : OR
Zip : 97222-2891
Country : US
Telephone Number : 503-546-6377
Fax Number : 503-546-9397
Provider Business Practice Location Address
First Line : 6200 SE KING RD
Second Line :
City : PORTLAND
State : OR
Zip : 97222-2891
Country : US
Telephone Number : 503-546-6377
Fax Number : 503-546-9397
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2014
Last Update Date : 11/11/2014

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