MEDICARE: MARIELA ROMAN PA

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	363A00000X	Physician Assistant	0010-16161	NC

General Provider Information

NPI Number	:	1861230658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIELA ROMAN PA

Provider Business Mailing Address
First Line	:	PO BOX 4569
Second Line	:
City	:	SAN SEBASTIAN
State	:	PR
Zip	:	00685-4569
Country	:	US
Telephone Number	:	787-371-6379
Fax Number	:

Provider Business Practice Location Address
First Line	:	CARR 172 URB TURABO GARDENS
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725
Country	:	US
Telephone Number	:	787-653-0550
Fax Number	:

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

Provider Enumeration Date	:	07/17/2024
Last Update Date	:	04/09/2026

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Directions to “ MARIELA ROMAN PA” Practice Location

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