Provider Demographics
NPI:1831249572
Name:ROMAN, CARMEN (MD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3026 CADENCIA ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-8307
Mailing Address - Country:US
Mailing Address - Phone:760-317-8494
Mailing Address - Fax:
Practice Address - Street 1:611 VETERANS BLVD STE 217
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1401
Practice Address - Country:US
Practice Address - Phone:650-465-3129
Practice Address - Fax:650-260-2953
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA359972084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A35997Medicaid