Healthcare Provider Details

I. General information

NPI: 1760285332
Provider Name (Legal Business Name): ALEXIS JADRIEL ROMAN SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALEXIS JADRIEL ROMAN SR.

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB FLORAL PARK CALLE SALVADOR BRAU 404
SAN JUAN PR
00917-3519
US

IV. Provider business mailing address

URB FLORAL PARK CALLE SALVADOR BRAU 404
SAN JUAN PR
00917-3519
US

V. Phone/Fax

Practice location:
  • Phone: 787-478-1423
  • Fax: 787-478-1423
Mailing address:
  • Phone: 787-478-1423
  • Fax: 787-478-1423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number16148
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: