Healthcare Provider Details

I. General information

NPI: 1679127955
Provider Name (Legal Business Name): ANGELA M ROMERO CADTP 15424
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 06/25/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4452 E. CESAR CHAVEZ BLVD
FRESNO CA
93702
US

IV. Provider business mailing address

4452 E. CESAR CHAVEZ BLVD FRESNO, CA 93702
FRESNO CA
93702
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-9180
  • Fax:
Mailing address:
  • Phone: 559-600-6068
  • Fax: 559-600-9135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: