Healthcare Provider Details

I. General information

NPI: 1134830375
Provider Name (Legal Business Name): VANESSA ROMERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1671 THE ALAMEDA STE 306
SAN JOSE CA
95126-2222
US

IV. Provider business mailing address

1501 W WELDON AVE
FRESNO CA
93705-4831
US

V. Phone/Fax

Practice location:
  • Phone: 669-208-4068
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: