MEDICARE: YAZMIN YADIRA ROMAN PEREZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist	1395	PR

General Provider Information

NPI Number	:	1356508832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAZMIN YADIRA ROMAN PEREZ

Provider Business Mailing Address
First Line	:	K16 CALLE ANON
Second Line	:	VALLE ARRIBA HEIGHTS
City	:	CAROLINA
State	:	PR
Zip	:	00983-3464
Country	:	US
Telephone Number	:	787-602-9431
Fax Number	:

Provider Business Practice Location Address
First Line	:	CARRETERA 3 KM 199
Second Line	:
City	:	CANOVANAS
State	:	PR
Zip	:	00729-0000
Country	:	US
Telephone Number	:	787-256-5555
Fax Number	:	787-256-5555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	05/21/2008

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Directions to “ YAZMIN YADIRA ROMAN PEREZ ” Practice Location

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