Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003039090 |
---|---|
Provider Name | Jose L. Romero |
First Address | Cathedral City, CA 92234-3388 |
Second Address | Cathedral City, CA 92234-3388 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 22/08/2007 |