Provider Demographics
NPI:1457117921
Name:FERNANDEZ ROMAN, ANA P
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:P
Last Name:FERNANDEZ ROMAN
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 1:13460 SW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6913
Mailing Address - Country:US
Mailing Address - Phone:305-370-5939
Mailing Address - Fax:
Practice Address - Street 1:7355 SW 87TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3565
Practice Address - Country:US
Practice Address - Phone:305-854-2462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty