Healthcare Provider Details

I. General information

NPI: 1437825783
Provider Name (Legal Business Name): ROMO AVALOS ATC, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 CERVEZA DR
ESCONDIDO CA
92026-6211
US

IV. Provider business mailing address

10240 CERVEZA DR
ESCONDIDO CA
92026-6211
US

V. Phone/Fax

Practice location:
  • Phone: 760-504-3492
  • Fax:
Mailing address:
  • Phone: 760-504-3492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number309120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: