Provider Demographics
NPI:1740094002
Name:ROMAN MARTRUS, MARIA DE LOS ANGELES
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DE LOS ANGELES
Last Name:ROMAN MARTRUS
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 1:11202NW 83ST
Mailing Address - Street 2:APT 214
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33178
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11202 NW 83RD ST APT 214
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-1752
Practice Address - Country:US
Practice Address - Phone:786-356-1837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-398831106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty