MEDICARE: ANA MERCEDES ROMAN ASW

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	1041C0700X	Clinical Social Worker	137974	CA

General Provider Information

NPI Number	:	1124508346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA MERCEDES ROMAN ASW

Provider Business Mailing Address
First Line	:	1261 TRAVIS BLVD STE 350
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-4825
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1261 TRAVIS BLVD STE 350
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-4825
Country	:	US
Telephone Number	:	707-246-0268
Fax Number	:

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

Provider Enumeration Date	:	08/16/2018
Last Update Date	:	04/07/2026

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