Healthcare Provider Details

I. General information

NPI: 1841647724
Provider Name (Legal Business Name): GENELE GRACE ROMERO NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

21838 CAROLDALE AVE
CARSON CA
90745-2835
US

V. Phone/Fax

Practice location:
  • Phone: 310-292-6611
  • Fax:
Mailing address:
  • Phone: 310-292-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95003636
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF1115259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: