Provider Demographics
NPI:1295305084
Name:ROMERO, JOSE LUIS JR (N/A)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:LUIS
Last Name:ROMERO
Suffix:JR
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 GRANITE AVE APT B
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-8240
Mailing Address - Country:US
Mailing Address - Phone:323-448-9876
Mailing Address - Fax:
Practice Address - Street 1:2107 1ST ST. EUREKA. CA. 95501
Practice Address - Street 2:N/A
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501
Practice Address - Country:US
Practice Address - Phone:707-273-6395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)