Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 18970 | PR |
N | 2084N0402X | Child Neurologist | 18970 | PR |
N | 2084N0402X | Child Neurologist | 2016-01382 | NC |
Y | 2084N0402X | Child Neurologist | ME133918 | FL |
NPI | 1184817256 |
---|---|
Provider Name | Dr. Carmen Rosa Fortuno Roman |
First Address | Orlando, FL 32819-4206 |
Second Address | Orlando, FL 32819-4206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2007 |
Last Update Date | 06/12/2021 |