Healthcare Provider Details

I. General information

NPI: 1821219296
Provider Name (Legal Business Name): AIXA M. ROMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

P12 AVE MAGNOLIA
BAYAMON PR
00956-2608
US

IV. Provider business mailing address

D27 CALLE PALOMA URB. LAS GAVIOTAS
TOA BAJA PR
00949-3471
US

V. Phone/Fax

Practice location:
  • Phone: 787-785-9282
  • Fax:
Mailing address:
  • Phone: 787-646-8145
  • Fax: 787-785-9290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH LOPEZ
Title or Position: ADMINISTRADORA
Credential:
Phone: 787-785-9282