Provider Demographics
NPI:1235549858
Name:ROMAN TEISSONNIERE, MORAIMA
Entity Type:Individual
Prefix:
First Name:MORAIMA
Middle Name:
Last Name:ROMAN TEISSONNIERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 CALLE CORAL
Mailing Address - Street 2:URB. VALLE COSTERO
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-3204
Mailing Address - Country:US
Mailing Address - Phone:787-222-2104
Mailing Address - Fax:
Practice Address - Street 1:3309 CALLE CORAL
Practice Address - Street 2:URB. VALLE COSTERO
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-3204
Practice Address - Country:US
Practice Address - Phone:787-222-2104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR04662471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography