Provider Demographics
NPI:1306176698
Name:ROMAN, YANITZA (004889)
Entity type:Individual
Prefix:MRS
First Name:YANITZA
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:004889
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 141133
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-1133
Mailing Address - Country:US
Mailing Address - Phone:787-243-6850
Mailing Address - Fax:
Practice Address - Street 1:CARR 493 KM 0.5 BO.CARRIZALES
Practice Address - Street 2:MEDICAL PROFESSIONAL OFFICE PLAZA SUITE 111
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-243-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist