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NPI Code Detail

MEDICARE: MR. ROMAN JERMAINE RICHARDSON

MEDICARE: MR. ROMAN JERMAINE RICHARDSON
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
1171M00000XCase Manager/Care Coordinator
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1942628664
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROMAN JERMAINE RICHARDSON
Provider Business Mailing Address
First Line : 1333 S MAYFLOWER AVE STE 220
Second Line :
City : MONROVIA
State : CA
Zip : 91016-5239
Country : US
Telephone Number : 818-241-6780
Fax Number :
Provider Business Practice Location Address
First Line : 5400 SUNCREST DR STE D1
Second Line :
City : EL PASO
State : TX
Zip : 79912-5615
Country : US
Telephone Number : 818-241-6780
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2014
Last Update Date : 05/26/2022

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