Healthcare Provider Details

I. General information

NPI: 1700436359
Provider Name (Legal Business Name): JEFFREY EDUARDO ROMO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5603 S CENTRAL AVE
LOS ANGELES CA
90011-5967
US

IV. Provider business mailing address

5603 S CENTRAL AVE
LOS ANGELES CA
90011-5967
US

V. Phone/Fax

Practice location:
  • Phone: 323-432-3700
  • Fax:
Mailing address:
  • Phone: 323-234-4445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: