Provider Demographics
NPI:1073134482
Name:OJEDA MARIN, ROMAN ENRIQUE (SA-C)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:ENRIQUE
Last Name:OJEDA MARIN
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 CLEARY BLVD APT 110
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-6039
Mailing Address - Country:US
Mailing Address - Phone:305-316-4887
Mailing Address - Fax:
Practice Address - Street 1:10701 CLEARY BLVD APT 110
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-6039
Practice Address - Country:US
Practice Address - Phone:305-316-4887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-204246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant