Active NPI
Pedro Ismael Romero, MPT
- Physical Therapist
- Rancho Cucamonga, CA
National Provider Identifier
1811971682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT28655
- Practice address
- 11276 5TH St
Ste 400 & 450
Rancho Cucamonga, CA 91730-0921 - Phone
- (909) 481-0437
- Fax
- (909) 481-0837
- NPI assigned
- Dec 5, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT28655 | CA | Primary |
Addresses
Primary practice location
11276 5TH St
Ste 400 & 450
Rancho Cucamonga, CA 91730-0921
Mailing address
24630 Washington Ave
Ste 200
Murrieta, CA 92562-6177
Phone (951) 696-9353
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0PT286550 | Other | CA | BLUE SHIELD |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT28655 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276128000000",
"number": "1811971682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24630 WASHINGTON AVE",
"address_2": "STE 200",
"city": "MURRIETA",
"state": "CA",
"postal_code": "925626177",
"telephone_number": "951-696-9353",
"fax_number": "951-973-7216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11276 5TH ST",
"address_2": "STE 400 & 450",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917300921",
"telephone_number": "909-481-0437",
"fax_number": "909-481-0837"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROMERO",
"first_name": "PEDRO",
"middle_name": "ISMAEL",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-05",
"last_updated": "2010-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT28655",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "0PT286550",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rancho Cucamonga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.