Basic Information
| Provider Information | |||||||||
| NPI: | 1114354230 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROMERO ORDONEZ | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ROMEROORDENEZ | ||||||||
| OtherFirstName: | DOUGLAS | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 555 N PERRIS BLVD | ||||||||
| Address2: | BLDG. A | ||||||||
| City: | PERRIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925712811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514365300 | ||||||||
| FaxNumber: | 9514365350 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 N PERRIS BLVD | ||||||||
| Address2: | BLDG. A | ||||||||
| City: | PERRIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925712811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514365300 | ||||||||
| FaxNumber: | 9514365350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2013 | ||||||||
| LastUpdateDate: | 10/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.