Provider Demographics
NPI:1497061147
Name:ROMAN, DANIEL
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:ROMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVENUE 181 STREET 745 K.M 5.4 ESPINO MORENA
Mailing Address - Street 2:HC 30 BOX 33610
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-9737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AVENUE 181 STREET 745 K.M 5.4 ESPINO MORENA
Practice Address - Street 2:HC 30 BOX 33610
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-9737
Practice Address - Country:US
Practice Address - Phone:787-736-8834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR843224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant