Healthcare Provider Details

I. General information

NPI: 1598522849
Provider Name (Legal Business Name): RICHARD ALEXANDER ROMERO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 E 17TH ST
SANTA ANA CA
92701-2641
US

IV. Provider business mailing address

1021 SIERRA VISTA DR
LA HABRA CA
90631-2767
US

V. Phone/Fax

Practice location:
  • Phone: 714-352-2911
  • Fax: 714-352-2903
Mailing address:
  • Phone: 562-501-8829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA64581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: