MEDICARE: DR. MARIA DEL CARMEN ROMAN

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	103T00000X	Psychologist	PSY 28460	CA
2	103TF0000X	Family Psychologist	PSY 28460	CA
3	103TP2701X	Group Psychotherapy Psychologist	PSY 28460	CA
4	103TC0700X	Clinical Psychologist	PSY 28460	CA

General Provider Information

NPI Number	:	1639623127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA DEL CARMEN ROMAN

Provider Business Mailing Address
First Line	:	PO BOX 26817
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95159-6817
Country	:	US
Telephone Number	:	650-223-5980
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 THE ALAMEDA STE 104
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2341
Country	:	US
Telephone Number	:	650-223-5980
Fax Number	:

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

Provider Enumeration Date	:	08/12/2016
Last Update Date	:	05/30/2024

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