Provider Demographics
NPI:1235726365
Name:ROMAN, RUTH (MSN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17187 AVENUE DEL SOL
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-7949
Mailing Address - Country:US
Mailing Address - Phone:909-904-5479
Mailing Address - Fax:
Practice Address - Street 1:17187 AVENUE DEL SOL
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-7949
Practice Address - Country:US
Practice Address - Phone:909-904-5479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily