Provider Demographics
NPI:1043514409
Name:ROMAN, DAVID GAXIOLA
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GAXIOLA
Last Name:ROMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-2845
Mailing Address - Country:US
Mailing Address - Phone:760-482-2927
Mailing Address - Fax:760-337-7885
Practice Address - Street 1:1295 W STATE ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2845
Practice Address - Country:US
Practice Address - Phone:760-482-2927
Practice Address - Fax:760-337-7885
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor