Provider Demographics
NPI:1760022446
Name:ROMAN, MAYRA ANABELA (PHD)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:ANABELA
Last Name:ROMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MAYRA
Other - Middle Name:ANABELA
Other - Last Name:ROMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 1918
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659
Mailing Address - Country:US
Mailing Address - Phone:787-356-4125
Mailing Address - Fax:
Practice Address - Street 1:CARR 119 KM 0.3 AVE. INO ROMAN
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-356-4125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist