Healthcare Provider Details

I. General information

NPI: 1417654468
Provider Name (Legal Business Name): NICOLE BREANN ROMIG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 GRANT RD
MOUNTAIN VIEW CA
94040-3292
US

IV. Provider business mailing address

1503 GRANT RD STE 110
MOUNTAIN VIEW CA
94040-3270
US

V. Phone/Fax

Practice location:
  • Phone: 650-484-1213
  • Fax: 650-484-1296
Mailing address:
  • Phone: 408-261-7777
  • Fax: 408-642-6052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: