Provider Demographics
NPI:1407473028
Name:ROMAN, GLORIMAR (MS)
Entity Type:Individual
Prefix:MS
First Name:GLORIMAR
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR 199 CONDOMINIO LA CIUDADELA
Mailing Address - Street 2:APT C-117
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-212-4176
Mailing Address - Fax:
Practice Address - Street 1:URB SANTIAGO IGLESIAS
Practice Address - Street 2:AVE PAZ GRANELA 1436
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-212-4176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4165235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist