Provider Demographics
NPI:1952770729
Name:ROMAN, ADELIS ORTIZ
Entity Type:Individual
Prefix:MS
First Name:ADELIS
Middle Name:ORTIZ
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 1:2 CALLE 5
Mailing Address - Street 2:BDA. LA PLATA
Mailing Address - City:COMERIO
Mailing Address - State:PR
Mailing Address - Zip Code:00782
Mailing Address - Country:US
Mailing Address - Phone:787-595-3120
Mailing Address - Fax:
Practice Address - Street 1:15 CALLE GEORGETTI
Practice Address - Street 2:
Practice Address - City:COMERIO
Practice Address - State:PR
Practice Address - Zip Code:00782-2542
Practice Address - Country:US
Practice Address - Phone:787-875-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7146183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician