Healthcare Provider Details

I. General information

NPI: 1376193177
Provider Name (Legal Business Name): VINCENZO GIROLAMO ROMA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 01/31/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIR
OCEANSIDE CA
92055
US

IV. Provider business mailing address

200 MERCY CIR
OCEANSIDE CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-719-3312
  • Fax:
Mailing address:
  • Phone: 760-719-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2729
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number31496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: