Provider Demographics
NPI:1417389446
Name:ROMAN, GLADYS MIRIAM
Entity Type:Individual
Prefix:MS
First Name:GLADYS
Middle Name:MIRIAM
Last Name:ROMAN
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 1:70 CALLE SERAFIN MENDEZ
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-5211
Mailing Address - Country:US
Mailing Address - Phone:787-379-1305
Mailing Address - Fax:
Practice Address - Street 1:70 CALLE SERAFIN MENDEZ
Practice Address - Street 2:
Practice Address - City:MOCQ
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-379-1305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1068235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist