MEDICARE: ROMO AVALOS ATC, DPT

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	2255A2300X	Athletic Trainer		CA
2	225100000X	Physical Therapist	309120	CA

General Provider Information

NPI Number	:	1437825783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROMO AVALOS ATC, DPT

Provider Business Mailing Address
First Line	:	10240 CERVEZA DR
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92026-6211
Country	:	US
Telephone Number	:	760-504-3492
Fax Number	:

Provider Business Practice Location Address
First Line	:	10240 CERVEZA DR
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92026-6211
Country	:	US
Telephone Number	:	760-504-3492
Fax Number	:

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

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	12/10/2025

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