Healthcare Provider Details

I. General information

NPI: 1598671513
Provider Name (Legal Business Name): JENNIFER LYZ ROMAN PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN GERMAN MEDICAL PLAZA STE. 202
SAN GERMAN PR
00683
US

IV. Provider business mailing address

URB. VILLA DEL CARMEN 851 CALLE SENTINA
PONCE PR
00716
US

V. Phone/Fax

Practice location:
  • Phone: 787-438-9815
  • Fax:
Mailing address:
  • Phone: 939-240-1475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4382
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: