Provider Demographics
NPI:1104160563
Name:ROMAN, JULISSA VERONICA
Entity type:Individual
Prefix:MISS
First Name:JULISSA
Middle Name:VERONICA
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 1:1122 SW 87TH AVE # A5
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3266
Mailing Address - Country:US
Mailing Address - Phone:786-470-0375
Mailing Address - Fax:
Practice Address - Street 1:1122 SW 87TH AVE # A5
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3266
Practice Address - Country:US
Practice Address - Phone:786-470-0375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-23
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker