Provider Demographics
NPI:1881473114
Name:ROMAN SANCHEZ, GILBERTO (JEP)
Entity type:Individual
Prefix:MR
First Name:GILBERTO
Middle Name:
Last Name:ROMAN SANCHEZ
Suffix:
Gender:M
Credentials:JEP
Other - Prefix:MR
Other - First Name:GILBERTO
Other - Middle Name:
Other - Last Name:ROMAN SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8650
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8650
Mailing Address - Country:US
Mailing Address - Phone:787-651-7691
Mailing Address - Fax:
Practice Address - Street 1:2972 AVE EMILIO FAGOT
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-3615
Practice Address - Country:US
Practice Address - Phone:787-651-7691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRJEPPR2900103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty