Provider Demographics
NPI:1194379578
Name:ROMAN-NEGRON, CESAR ENRIQUE (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:ENRIQUE
Last Name:ROMAN-NEGRON
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:CESAR
Other - Middle Name:E
Other - Last Name:ROMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LAT, ATC
Mailing Address - Street 1:8138 SUTTON PL E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4437
Mailing Address - Country:US
Mailing Address - Phone:787-671-2885
Mailing Address - Fax:
Practice Address - Street 1:1325 SAN MARCO BLVD STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8566
Practice Address - Country:US
Practice Address - Phone:904-346-3465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL23772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer