Provider Demographics
NPI:1417715558
Name:NEPOMUCENO, ROMAN GABRIEL (MD)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:GABRIEL
Last Name:NEPOMUCENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11401 PORTER RANCH DR APT 6304
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4645
Mailing Address - Country:US
Mailing Address - Phone:424-473-3705
Mailing Address - Fax:
Practice Address - Street 1:11401 PORTER RANCH DR APT 6304
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-4645
Practice Address - Country:US
Practice Address - Phone:424-473-3705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA194636207P00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine