MEDICARE: VANESSA ROMAN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95036236	CA

General Provider Information

NPI Number	:	1982587259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA ROMAN

Provider Business Mailing Address
First Line	:	322 CULVER BLVD # 1182
Second Line	:
City	:	PLAYA DEL REY
State	:	CA
Zip	:	90293-7704
Country	:	US
Telephone Number	:	323-403-8058
Fax Number	:

Provider Business Practice Location Address
First Line	:	322 CULVER BLVD # 1182
Second Line	:
City	:	PLAYA DEL REY
State	:	CA
Zip	:	90293-7704
Country	:	US
Telephone Number	:	323-403-8058
Fax Number	:

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

Provider Enumeration Date	:	07/25/2025
Last Update Date	:	08/08/2025

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Directions to “ VANESSA ROMAN ” Practice Location

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