Healthcare Provider Details

I. General information

NPI: 1255667887
Provider Name (Legal Business Name): SANDRO ROMERO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 KILROY AIRPORT WAY STE 100
LONG BEACH CA
90806-6818
US

IV. Provider business mailing address

3761 CIMARRON ST
LOS ANGELES CA
90018-4344
US

V. Phone/Fax

Practice location:
  • Phone: 213-669-6453
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20664
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: