Provider Demographics
NPI:1528720828
Name:ROMAN, ELIZABETH (LND)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:LND
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 190
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0190
Mailing Address - Country:US
Mailing Address - Phone:787-831-5800
Mailing Address - Fax:787-832-0740
Practice Address - Street 1:CALLE RAMON EMETERIO BETANCES
Practice Address - Street 2:#491 SUR
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-0000
Practice Address - Country:US
Practice Address - Phone:787-831-5800
Practice Address - Fax:787-832-0740
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1386133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist