Provider Demographics
NPI:1952613861
Name:ROMAN, CORAL M (MS)
Entity Type:Individual
Prefix:MS
First Name:CORAL
Middle Name:M
Last Name:ROMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE SAN JUSTO 149
Mailing Address - Street 2:APT. 104 PISOS DON MANUEL
Mailing Address - City:SAN JUAN
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00901
Mailing Address - Country:UM
Mailing Address - Phone:939-639-4901
Mailing Address - Fax:
Practice Address - Street 1:149 CALLE SAN JUSTO PISOS DON MANUEL
Practice Address - Street 2:APT 104
Practice Address - City:SAN JUAN
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00901
Practice Address - Country:UM
Practice Address - Phone:939-639-4901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4518250172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver