Provider Demographics
NPI:1740537364
Name:ROMAN, BENNY J (EMT)
Entity type:Individual
Prefix:MR
First Name:BENNY
Middle Name:J
Last Name:ROMAN
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE ARMANDO REYES #12 URB. LA MONSERRATE
Mailing Address - Street 2:
Mailing Address - City:JAYUYA
Mailing Address - State:PR
Mailing Address - Zip Code:00664-0000
Mailing Address - Country:US
Mailing Address - Phone:787-828-2635
Mailing Address - Fax:
Practice Address - Street 1:CALLE ARMANDO REYES #12 URB. LA MONSERRATE
Practice Address - Street 2:
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664-1201
Practice Address - Country:US
Practice Address - Phone:787-828-2635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4315537347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle