Provider Demographics
NPI:1033921176
Name:ROMAN, PEDRO J
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:J
Last Name: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 1:12855 SW 136TH AVE STE 218
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5828
Mailing Address - Country:US
Mailing Address - Phone:786-447-3530
Mailing Address - Fax:
Practice Address - Street 1:12855 SW 136TH AVE STE 218
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5828
Practice Address - Country:US
Practice Address - Phone:786-447-3530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9489980163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse