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Export Provider Record NPI 1104803584
Angel F San RomanMD
Active
NPI Number1104803584
NPI TypeNPI-1 Individual
SpecialtyPediatrics
Provider Details
NPI1104803584
NPI TypeNPI-1 Individual
StatusActive
Enumeration Date2005-12-28
Last Updated2016-08-23
Mailing Address5965 Ponce De Leon Blvd, Suite 2
Coral Gables, FL 33146-2423
United States
Phone: (305) 663-2845 | Fax: (305) 663-9361
📍 View Map
Primary Practice Address5965 Ponce De Leon Blvd, Suite 2
Coral Gables, FL 33146-2423
United States
Phone: (305) 663-2845 | Fax: (305) 663-9361
📍 View Map
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDFL063497200-
Taxonomy / Specialty
PrimaryTaxonomy Code & DescriptionStateLicense Number
Yes208000000X – PediatricsFLME55882
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About NPI 1104803584

Angel F San Roman MD is a healthcare provider registered in the CMS NPPES NPI Registry with NPI number 1104803584. The primary specialty listed is Pediatrics. The provider is located in Coral Gables, FL. This NPI is classified as a Type 1 (Individual) NPI and is currently active. The NPI was first enumerated (assigned) on 2005-12-28. All data is sourced directly from the official CMS NPPES public API and is updated daily.

Frequently Asked Questions

What is NPI 1104803584?

NPI 1104803584 belongs to Angel F San Roman MD, a Pediatrics in Coral Gables, FL. It is a Type 1 Individual NPI registered in the CMS NPPES NPI Registry.

Is NPI 1104803584 active?

The current status of NPI 1104803584 in the NPPES registry is Active. The record was last updated on 2016-08-23.

What specialty is NPI 1104803584?

NPI 1104803584 is classified under the taxonomy Pediatrics. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.

How do I verify NPI 1104803584?

You can verify NPI 1104803584 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.

What address is on file for NPI 1104803584?

The primary practice address on file for NPI 1104803584 is 5965 Ponce De Leon Blvd, Coral Gables, FL 33146-2423. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.

When was NPI 1104803584 issued?

NPI 1104803584 was first issued (enumerated) on 2005-12-28. The NPPES record was last updated on 2016-08-23.

Practice Location Map

Angel F San Roman is located at 5965 Ponce De Leon Blvd, Coral Gables, FL. Use the map below to find directions or verify the practice location.

📍 5965 Ponce De Leon Blvd, Coral Gables, FL 33146-2423  ·  Open in Google Maps ↗

Related Healthcare Providers

The following providers share the same practice location, specialty, or state as Angel F San Roman. All records sourced from the CMS NPPES registry.

License Information

The following state license numbers are on file in the NPPES registry for NPI 1104803584. For license status verification, contact the relevant state licensing board directly.

Specialty / TaxonomyLicense NumberState
PediatricsME55882FL
Data Verified from CMS NPPES Last synced: 2026-08-10 · Source: npiregistry.cms.hhs.gov · 45 CFR Part 162