Provider Demographics
NPI:1184817256
Name:FORTUNO ROMAN, CARMEN ROSA (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:ROSA
Last Name:FORTUNO ROMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 TURKEY LAKE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4206
Mailing Address - Country:US
Mailing Address - Phone:407-649-1848
Mailing Address - Fax:407-649-1979
Practice Address - Street 1:6000 TURKEY LAKE RD STE 205
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4206
Practice Address - Country:US
Practice Address - Phone:407-649-1848
Practice Address - Fax:407-649-1979
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18970208000000X, 2084N0402X
NC2016-013822084N0402X
FLME1339182084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics