Healthcare Provider Details

I. General information

NPI: 1265934855
Provider Name (Legal Business Name): HOLLY ANN ROMERO SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8660 BRENTWOOD BLVD. SUITE C
BRENTWOOD CA
94513-9451
US

IV. Provider business mailing address

8660 BRENTWOOD BLVD. SUITE C
BRENTWOOD CA
94513
US

V. Phone/Fax

Practice location:
  • Phone: 925-626-7474
  • Fax: 914-481-7524
Mailing address:
  • Phone: 925-626-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number4017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: