Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 34413 | CA |
NPI | 1164544904 |
---|---|
Provider Name | Dr. Guillermo A Roman |
First Address | Encino, CA 91436-4350 |
Second Address | Encino, CA 91436-4350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 13/05/2019 |