1336370907 NPI number — GALEN RONNIE ROMERO CMHC

Table of content: GALEN RONNIE ROMERO CMHC (NPI 1336370907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336370907 NPI number — GALEN RONNIE ROMERO CMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMERO
Provider First Name:
GALEN
Provider Middle Name:
RONNIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CMHC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336370907
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 460
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOUNTIFUL
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84011-0460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-298-3446
Provider Business Mailing Address Fax Number:
801-298-3449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
811 N HARRISVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISVILLE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84404-3537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-399-1818
Provider Business Practice Location Address Fax Number:
801-782-8412
Provider Enumeration Date:
07/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  364777-6009 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1336370907 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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