Healthcare Provider Details

I. General information

NPI: 1689017873
Provider Name (Legal Business Name): TANIA ROMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 MADISON OAK DR STE 210
SAN ANTONIO TX
78258-4192
US

IV. Provider business mailing address

PO BOX 2271
SAN ANTONIO TX
78298-2271
US

V. Phone/Fax

Practice location:
  • Phone: 210-481-3000
  • Fax: 210-567-3013
Mailing address:
  • Phone: 210-481-3000
  • Fax: 210-567-3013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberR2957
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: