Provider Demographics
NPI:1558176396
Name:ROMAN, MAKAYLA N
Entity type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:N
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 1:1830 E BROADWAY BLVD STE 124-316
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-5966
Mailing Address - Country:US
Mailing Address - Phone:520-232-2021
Mailing Address - Fax:520-232-2553
Practice Address - Street 1:5700 E PIMA ST STE G
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5638
Practice Address - Country:US
Practice Address - Phone:520-232-2021
Practice Address - Fax:520-232-2553
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician