Healthcare Provider Details

I. General information

NPI: 1114668571
Provider Name (Legal Business Name): GABRIEL PEDRO ROMERO FLORESCIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 07/07/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 S SAN PEDRO ST
LOS ANGELES CA
90013-2102
US

IV. Provider business mailing address

522 S SAN PEDRO ST
LOS ANGELES CA
90013-2102
US

V. Phone/Fax

Practice location:
  • Phone: 661-948-1228
  • Fax:
Mailing address:
  • Phone: 661-948-1228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberV3000
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA199781
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: