MEDICARE: MARA YAHAIRA PALACIOS ROMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	17640I	PR

General Provider Information

NPI Number	:	1023950797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARA YAHAIRA PALACIOS ROMAN MD

Provider Business Mailing Address
First Line	:	E2 CALLE ZAFIRO
Second Line	:	URB EXT SANTA ANA
City	:	VEGA ALTA
State	:	PR
Zip	:	00692
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 AVE LUIS MUNOZ MARIN
Second Line	:	URB MARIOLGA
City	:	CAGUAS
State	:	PR
Zip	:	00725
Country	:	US
Telephone Number	:	787-653-3434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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