Provider Demographics
NPI:1316452238
Name:GONZALEZ-ROMAN, FREDERICK SAUL
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:SAUL
Last Name:GONZALEZ-ROMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 CALLE LOS PRIETOS
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-2540
Mailing Address - Country:US
Mailing Address - Phone:787-585-3240
Mailing Address - Fax:
Practice Address - Street 1:449 CALLE LOS PRIETOS
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-2540
Practice Address - Country:US
Practice Address - Phone:787-585-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR011194183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician