Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 4086071 | AZ |
NPI | 1023252533 |
---|---|
Provider Name | Mr. Jason Romero |
First Address | Phoenix, AZ 85033-4517 |
Second Address | Phoenix, AZ 85033-4517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2009 |
Last Update Date | 28/04/2009 |