Healthcare Provider Details

I. General information

NPI: 1679604714
Provider Name (Legal Business Name): KENNETH A. ROMERO, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

752 MEDICAL CENTER CT
CHULA VISTA CA
91911-6658
US

IV. Provider business mailing address

5 HOLLAND STE 101
IRVINE CA
92618-2568
US

V. Phone/Fax

Practice location:
  • Phone: 619-482-5800
  • Fax:
Mailing address:
  • Phone: 949-588-2190
  • Fax: 949-588-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberG66351
License Number StateCA

VIII. Authorized Official

Name: DEBORAH SIGMAN
Title or Position: MANAGER
Credential:
Phone: 949-588-2190