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General NPI Number Information
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NPI Number | 1164192456
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Entity Type | Individual
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Provider Name | SAMUEL SANTIAGO PARRA ROMERO TPP
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Gender | Male
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Dates
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Enumeration Date | 09/17/2021
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 790 S STATE ST STE 6
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City | SAN JACINTO
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State | CA
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Zip | 92583-4924
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Country | US
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Telephone | 951-654-6062
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Fax | 951-602-8195
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Provider Business Mailing Address
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Address Line | 1300 W FLORIDA AVE STE B
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City | HEMET
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State | CA
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Zip | 92543-4628
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Country | US
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Telephone | 951-658-7122
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Fax | 951-658-7140
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | F5206142
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License Number State | CA
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