Provider Demographics
NPI:1942089412
Name:ROMAN SANTOS, ZORALY
Entity Type:Individual
Prefix:
First Name:ZORALY
Middle Name:
Last Name:ROMAN SANTOS
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 1:3168 ROYAL TERN DR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-7305
Mailing Address - Country:US
Mailing Address - Phone:407-346-0569
Mailing Address - Fax:
Practice Address - Street 1:207 E ROBERTSON ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5254
Practice Address - Country:US
Practice Address - Phone:813-369-5926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician