Provider Demographics
NPI:1740659630
Name:ROMAN, JESENIA
Entity type:Individual
Prefix:
First Name:JESENIA
Middle Name:
Last Name: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:URBANIZACION SABANA DEL PALMAR
Mailing Address - Street 2:CALLE YAGRUMO 613
Mailing Address - City:COMERIO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00782
Mailing Address - Country:UM
Mailing Address - Phone:787-612-0729
Mailing Address - Fax:787-875-3550
Practice Address - Street 1:URBANIZACION SABANA DEL PALMAR
Practice Address - Street 2:CALLE YAGRUMO 613
Practice Address - City:COMERIO
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00782
Practice Address - Country:UM
Practice Address - Phone:787-612-0729
Practice Address - Fax:787-875-3550
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3958183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician