Healthcare Provider Details

I. General information

NPI: 1275489429
Provider Name (Legal Business Name): ADRIANA RENEE MAY ROMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22415 SE 231ST ST STE B103
MAPLE VALLEY WA
98038-5002
US

IV. Provider business mailing address

22459 SE 244TH ST
MAPLE VALLEY WA
98038-8506
US

V. Phone/Fax

Practice location:
  • Phone: 425-906-4300
  • Fax: 425-906-4300
Mailing address:
  • Phone: 425-906-4300
  • Fax: 425-906-4300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: