1407961832 NPI number — MRS. ELIZABETH ANN ROMO LCSW

Table of content: MRS. ELIZABETH ANN ROMO LCSW (NPI 1407961832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407961832 NPI number — MRS. ELIZABETH ANN ROMO LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMO
Provider First Name:
ELIZABETH
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOLINA
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407961832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 HARRISON ST FL 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94612-3466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-625-5356
Provider Business Mailing Address Fax Number:
877-738-4262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24800 CHRISANTA DR
Provider Second Line Business Practice Location Address:
SUITE, 220
Provider Business Practice Location Address City Name:
MISSION VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92691-4833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-292-3602
Provider Business Practice Location Address Fax Number:
949-707-5314
Provider Enumeration Date:
08/19/2006

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: 1041C0700X , with the licence number:  LCS, 21449 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11486678 . This is a "CAQH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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