Provider Demographics
NPI:1891378238
Name:SILVESTRE, ROMAN CARLO (PTA)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:CARLO
Last Name:SILVESTRE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7035 SANTA IRENE CIR APT 45
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4859
Mailing Address - Country:US
Mailing Address - Phone:562-446-3895
Mailing Address - Fax:
Practice Address - Street 1:7035 SANTA IRENE CIR APT 45
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4859
Practice Address - Country:US
Practice Address - Phone:562-446-3895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50235225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant