Individual provider Active NPI

Romeo Reyes Ladero Jr., NURSE PRACTITIONER

  • Gerontology Nurse Practitioner
  • Murrieta, CA
National Provider Identifier
1356869846
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
95008999 Issued in CA
Practice address
38340 Innovation CT # D-404
Murrieta, CA 92563-2621
Phone
(951) 721-2768
NPI assigned
Sep 5, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 95008999 CA Primary

Addresses

Primary practice location

38340 Innovation CT # D-404
Murrieta, CA 92563-2621

Mailing address

38340 Innovation CT # D-404
Murrieta, CA 92563-2621
Phone (951) 721-2768

Other identifiers 1

IdentifierTypeStateIssuer
1356869846MedicaidCA

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)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Innovamed Industries LLC Current Accepting new patients
Precisioncare Solutions LLC Gerontology CurrentSince Jun 9, 2024 Accepting new patients
H Squared Health CurrentSince Sep 27, 2020 Accepting new patients
Alliance Care Medical Equipment LLC Current Accepting new patients

Locations

38340 Innovation Ct
#D404
Murrieta, CA 92563
Phone (951) 721-2768

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1504569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1356869846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38340 INNOVATION CT # D-404",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925632621",
            "telephone_number": "951-721-2768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38340 INNOVATION CT # D-404",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925632621",
            "telephone_number": "951-721-2768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LADERO",
        "first_name": "ROMEO",
        "middle_name": "REYES",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-09-05",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CA",
            "license": "95008999",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356869846",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Murrieta, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; 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.