MEDICARE: MIREYA 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	101Y00000X	Counselor	MH12553	FL
2	174H00000X	Health Educator

General Provider Information

NPI Number	:	1851765085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIREYA ROMAN

Provider Business Mailing Address
First Line	:	8830 SW 123RD CT APT 402I
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-1966
Country	:	US
Telephone Number	:	305-815-3689
Fax Number	:

Provider Business Practice Location Address
First Line	:	8830 SW 123RD CT APT 402I
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-1966
Country	:	US
Telephone Number	:	305-815-3689
Fax Number	:

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

Provider Enumeration Date	:	11/27/2015
Last Update Date	:	11/27/2015

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Directions to “ MIREYA ROMAN ” Practice Location

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