=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760276265
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ISAMAR ROMERO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2025
-----------------------------------------------------
Last Update Date | 04/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2423 HOOVER AVE
-----------------------------------------------------
City | NATIONAL CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91950-6619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-385-1896
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3220 SWEETWATER RD
-----------------------------------------------------
City | LEMON GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91945-2001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-895-7150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------