Healthcare Provider Details

I. General information

NPI: 1619887726
Provider Name (Legal Business Name): YESENIA A ROMAN ROSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 628 KM 7.1 SECTOR MONTANA, BO. SABANA HOYOS
ARECIBO PR
00612
US

IV. Provider business mailing address

PO BOX 9574
ARECIBO PR
00613-9574
US

V. Phone/Fax

Practice location:
  • Phone: 939-335-1256
  • Fax:
Mailing address:
  • Phone: 939-335-1256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8278
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: