Provider Demographics
NPI:1740429190
Name:ROMAN MORA, GISELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:GISELLE
Middle Name:
Last Name:ROMAN MORA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE DORADO A20
Mailing Address - Street 2:142 ESTANCIAS DE MANATI
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-510-8186
Mailing Address - Fax:
Practice Address - Street 1:511 AVE JOSE A CEDENO
Practice Address - Street 2:SUITE 6
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4695
Practice Address - Country:US
Practice Address - Phone:787-880-3362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR660152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist