MEDICARE: SEBASTIAN ROMERO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1407550072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEBASTIAN ROMERO

Provider Business Mailing Address
First Line	:	289 BROMLEY CROSS DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95119-1816
Country	:	US
Telephone Number	:	650-619-3561
Fax Number	:

Provider Business Practice Location Address
First Line	:	1045 WILLOW ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-2346
Country	:	US
Telephone Number	:	877-910-6538
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2023
Last Update Date	:	03/28/2023

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Directions to “ SEBASTIAN ROMERO ” Practice Location

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