Provider Demographics
NPI:1356508832
Name:ROMAN PEREZ, YAZMIN YADIRA
Entity Type:Individual
Prefix:
First Name:YAZMIN
Middle Name:YADIRA
Last Name:ROMAN PEREZ
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:K16 CALLE ANON
Mailing Address - Street 2:VALLE ARRIBA HEIGHTS
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-3464
Mailing Address - Country:US
Mailing Address - Phone:787-602-9431
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 3 KM 199
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-0000
Practice Address - Country:US
Practice Address - Phone:787-256-5555
Practice Address - Fax:787-256-5555
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1395133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist