Provider Demographics
NPI:1437046893
Name:ROMERO GONZALEZ, LUIS ANTONIO
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ANTONIO
Last Name:ROMERO GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 PAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-2926
Mailing Address - Country:US
Mailing Address - Phone:408-893-6952
Mailing Address - Fax:
Practice Address - Street 1:25 E HEDDING ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-4910
Practice Address - Country:US
Practice Address - Phone:408-292-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1297101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical