Provider Demographics
NPI:1942440888
Name:ROMAN, DEBORAH V (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:V
Last Name:ROMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3124 ANDERSON DR
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1003
Mailing Address - Country:US
Mailing Address - Phone:805-584-8054
Mailing Address - Fax:
Practice Address - Street 1:1687 ERRINGER RD
Practice Address - Street 2:SUITE 109
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-6508
Practice Address - Country:US
Practice Address - Phone:805-584-8054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT3066208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ071672OtherBLUE SHIELD
CAW16539Medicare UPIN