Healthcare Provider Details

I. General information

NPI: 1164385548
Provider Name (Legal Business Name): JOSE LUIS ROMERO RAMIREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 BROADWAY ST
KING CITY CA
93930-3231
US

IV. Provider business mailing address

35 11TH ST
GREENFIELD CA
93927-5513
US

V. Phone/Fax

Practice location:
  • Phone: 831-525-8181
  • Fax:
Mailing address:
  • Phone: 831-677-8368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1420141025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: