Provider Demographics
NPI:1013208628
Name:ROMAN, JORGE EFRAIN (NP)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:EFRAIN
Last Name:ROMAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 TRANCAS ST STE 300
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2921
Mailing Address - Country:US
Mailing Address - Phone:707-254-1770
Mailing Address - Fax:707-254-1779
Practice Address - Street 1:1141 PEAR TREE LN
Practice Address - Street 2:SUITE 100
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6484
Practice Address - Country:US
Practice Address - Phone:707-254-1770
Practice Address - Fax:707-251-2995
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20679363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily