=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760316368
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHAD MATTHEW ROMOSER RADT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2026
-----------------------------------------------------
Last Update Date | 06/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1260 E ARROW HWY
-----------------------------------------------------
City | UPLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91786-4982
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-932-1069
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1260 E ARROW HWY
-----------------------------------------------------
City | UPLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91786-4982
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-932-1069
-----------------------------------------------------
Fax | 909-932-1069
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | RT1433230326
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------