Healthcare Provider Details

I. General information

NPI: 1952080624
Provider Name (Legal Business Name): JOSE LUIS ROMERO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2026 N IMPERIAL AVE STE C
EL CENTRO CA
92243-1607
US

IV. Provider business mailing address

1146 FAIRFIELD WAY
HEBER CA
92249-9512
US

V. Phone/Fax

Practice location:
  • Phone: 760-592-4352
  • Fax:
Mailing address:
  • Phone: 760-562-9326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95024947
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: