Healthcare Provider Details

I. General information

NPI: 1114394012
Provider Name (Legal Business Name): JEAN FRANCO ROMUALDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FRANCO ROMUALDEZ LMFT

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13611 FAIRMONT WAY
TUSTIN CA
92780-1810
US

IV. Provider business mailing address

13611 FAIRMONT WAY
TUSTIN CA
92780-1810
US

V. Phone/Fax

Practice location:
  • Phone: 408-531-5298
  • Fax:
Mailing address:
  • Phone: 408-531-5298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number134933
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: