Provider Demographics
NPI:1235848193
Name:ROMAN, NINOSHKA LEE (MEDICAL STUDENT)
Entity Type:Individual
Prefix:
First Name:NINOSHKA
Middle Name:LEE
Last Name:ROMAN
Suffix:
Gender:F
Credentials:MEDICAL STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 CALLE PABLO IGLESIAS
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-5223
Mailing Address - Country:US
Mailing Address - Phone:787-221-6395
Mailing Address - Fax:
Practice Address - Street 1:1139 CALLE PABLO IGLESIAS
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-5223
Practice Address - Country:US
Practice Address - Phone:787-221-6395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program