Basic Information
| Provider Information | |||||||||
| NPI: | 1225361272 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARRERA | ||||||||
| FirstName: | ROMMEL | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1199 PACIFIC HWY UNIT 703 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921018416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6193056616 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1202 MORENA BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921103842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192750822 | ||||||||
| FaxNumber: | 6192751422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2009 | ||||||||
| LastUpdateDate: | 04/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | 617028 | CA | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult | 163WP0808X | 617028 | CA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.