Individual provider Active NPI

Jose Antonio Romero

  • Mental Health Counselor
  • San Bernardino, CA
National Provider Identifier
1356774566
Registry record updated Mar 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
780 E Gilbert St
San Bernardino, CA 92415-8704
Phone
(909) 252-5132
NPI assigned
Aug 12, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X
Student in an Organized Health Care Education/Training Program 390200000X
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

780 E Gilbert St
San Bernardino, CA 92415-8704

Mailing address

975 Flynn Rd
Camarillo, CA 93012-8704
Phone (805) 445-7800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1376265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615939200000",
    "number": "1356774566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "975 FLYNN RD",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930128704",
            "telephone_number": "805-445-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 E GILBERT ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924158704",
            "telephone_number": "909-252-5132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROMERO",
        "first_name": "JOSE",
        "middle_name": "ANTONIO",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-12",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.