Provider Demographics
NPI:1750513875
Name:ROMAN, CESAR AUGUSTO (MA)
Entity type:Individual
Prefix:MR
First Name:CESAR
Middle Name:AUGUSTO
Last Name:ROMAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5504 36TH CT E
Mailing Address - Street 2:APT 204
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-8324
Mailing Address - Country:US
Mailing Address - Phone:305-790-6325
Mailing Address - Fax:
Practice Address - Street 1:5504 36TH CT E
Practice Address - Street 2:APT 204
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-8324
Practice Address - Country:US
Practice Address - Phone:305-790-6325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3428103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool