Provider Demographics
NPI:1669580650
Name:ROMAN ORTA, MARIA L (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:L
Last Name:ROMAN ORTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40 CAPRI
Mailing Address - Street 2:PASEO LAS BRISAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5947
Mailing Address - Country:US
Mailing Address - Phone:787-765-5678
Mailing Address - Fax:787-765-5206
Practice Address - Street 1:420 AVE. MUNOZ RIVERA
Practice Address - Street 2:SUITE 701
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-765-5678
Practice Address - Fax:787-765-5206
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR105912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF64262Medicare UPIN
PR0087768Medicare ID - Type Unspecified