Provider Demographics
NPI:1215688015
Name:ROMAN SOSA, DEBORA
Entity type:Individual
Prefix:
First Name:DEBORA
Middle Name:
Last Name:ROMAN SOSA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:DEBORA
Other - Middle Name:
Other - Last Name:ROMAN SOSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:162 CALLE DUARTE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-3513
Mailing Address - Country:US
Mailing Address - Phone:787-206-7713
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO MERCANTIL CAGUAX
Practice Address - Street 2:AVENIDA MUNOZ MARIN
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726-0425
Practice Address - Country:US
Practice Address - Phone:787-746-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15660-I390200000X
PR22875208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program