| Doctor Name: | MR. JOHAN MENNIG SAN ROMAN |
| NPI Number: | 1023290269 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | PA3409 |
| Business Practice Address: | 975 Baptist Way Homestead, FL - 330337600 |
| Business Phone Number: | 3057934706 |
| Business Fax Number: | |
| Mailing Address: | 6634 Sw 114th Pl, Unit A MIAMI |
| State: | FL |
| Postal Code: | 331731783 |
| Phone Number: | 3057934706 |
| Fax Number: | |
| NPI Enumeration Date: | 11/29/2007 |
| NPI Last Update Date: | 11/29/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA3409 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |