Healthcare Provider Details

I. General information

NPI: 1740603760
Provider Name (Legal Business Name): JULIE ROMERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14135 MAIN ST STE 301
HESPERIA CA
92345-8095
US

IV. Provider business mailing address

14135 MAIN ST STE 301
HESPERIA CA
92345-8095
US

V. Phone/Fax

Practice location:
  • Phone: 760-947-5220
  • Fax:
Mailing address:
  • Phone: 760-947-5220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number106086
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: