Provider Demographics
NPI:1740240092
Name:ROMAN - GARCIA, ANA JUDITH (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:JUDITH
Last Name:ROMAN - GARCIA
Suffix:
Gender:F
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:CONDOMINIO FIRST FEDERAL DE RIO PIEDRAS
Mailing Address - Street 2:1056 MUNOZ RIVERA AVE. SUITE 1003
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-5013
Mailing Address - Country:US
Mailing Address - Phone:787-765-3803
Mailing Address - Fax:787-765-3803
Practice Address - Street 1:CONDOMINIO FIRST FEDERAL DE RIO PIEDRAS
Practice Address - Street 2:1056 MUNOZ RIVERA AVE. SUITE 1003
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-5013
Practice Address - Country:US
Practice Address - Phone:787-765-3803
Practice Address - Fax:787-765-3803
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1968207R00000X, 2084N0400X
MA19682084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0022406OtherTRIPLE S
PR1300245OtherACAA
PR9270136OtherHUMANA
PR9270136OtherHUMANA
E66642Medicare UPIN