Provider Demographics
NPI:1689097867
Name:ROMAN, MIGUEL ANGEL SR (EMTP)
Entity Type:Individual
Prefix:PROF
First Name:MIGUEL
Middle Name:ANGEL
Last Name:ROMAN
Suffix:SR
Gender:M
Credentials:EMTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 CALLE CANILLAS
Mailing Address - Street 2:SAN JOSE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-1362
Mailing Address - Country:US
Mailing Address - Phone:787-662-7119
Mailing Address - Fax:
Practice Address - Street 1:266 CALLE CANILLAS
Practice Address - Street 2:SAN JOSE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923
Practice Address - Country:US
Practice Address - Phone:787-662-7119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2010146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic