Johan Mennig San Roman, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA3409 Issued in FL

Practice address

975 Baptist Way
Homestead, FL 33033-7600

Phone

(305) 793-4706

NPI assigned

Nov 29, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196294400000",
    "number": "1023290269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6634 SW 114TH PL",
            "address_2": "UNIT A",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331731783",
            "telephone_number": "305-793-4706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "975 BAPTIST WAY",
            "city": "HOMESTEAD",
            "state": "FL",
            "postal_code": "330337600",
            "telephone_number": "305-793-4706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENNIG SAN ROMAN",
        "first_name": "JOHAN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-29",
        "last_updated": "2007-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA3409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ingrid Menendez Regalado
• Maria Teresa Menendez Torres
• Helen Menendez
• Vanessa Menendez
• Madeline Menjivar Calles
• Elisabet Menocal Ramos
• Mental Health Center of South Florida, LLC
• Mental Health Network , Inc
• Mental Health Network, Inc
• Mental Healthnetwork , Inc

• Medical Physician Assistant in Homestead, FL
• Providers in Homestead, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.