Healthcare Provider Details

I. General information

NPI: 1104421155
Provider Name (Legal Business Name): GILES LEE GONZALES ROMERO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 MISSION ST
SAN FRANCISCO CA
94103-2626
US

IV. Provider business mailing address

1700 NEWBURY PARK DR APT 158
SAN JOSE CA
95133-1773
US

V. Phone/Fax

Practice location:
  • Phone: 628-217-7740
  • Fax:
Mailing address:
  • Phone: 775-247-3218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-140614
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: