MEDICARE: CELSO ROMAN HERNANDEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME28458	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063588820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELSO ROMAN HERNANDEZ MD

Provider Business Mailing Address
First Line	:	92140 OVERSEAS HWY
Second Line	:	SUITE 2
City	:	TAVERNIER
State	:	FL
Zip	:	33070-2636
Country	:	US
Telephone Number	:	305-852-7473
Fax Number	:	305-852-8962

Provider Business Practice Location Address
First Line	:	92140 OVERSEAS HWY
Second Line	:	SUITE 2
City	:	TAVERNIER
State	:	FL
Zip	:	33070-2636
Country	:	US
Telephone Number	:	305-852-7473
Fax Number	:	305-852-8962

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	02/01/2010

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