Healthcare Provider Details

I. General information

NPI: 1881410702
Provider Name (Legal Business Name): MAYRA T ROMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 486
SAN SEBASTIAN PR
00685-0486
US

IV. Provider business mailing address

D14 CALLE 3 VILLA RITA
SAN SEBASTIAN PR
00685-0486
US

V. Phone/Fax

Practice location:
  • Phone: 787-896-1850
  • Fax:
Mailing address:
  • Phone: 787-223-0857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number3584
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: