MEDICARE: DR. ERNESTO LUIS JUSINO ROMAN 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	207L00000X	Anesthesiology Physician	13524	PR

General Provider Information

NPI Number	:	1336203090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERNESTO LUIS JUSINO ROMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 66
Second Line	:
City	:	SAN GERMAN
State	:	PR
Zip	:	00683-0066
Country	:	US
Telephone Number	:	787-892-6972
Fax Number	:	787-892-6972

Provider Business Practice Location Address
First Line	:	2 CALLE CARRO
Second Line	:	HOSPITAL DE LA CONCEPCION 2ND FLOOR
City	:	SAN GERMAN
State	:	PR
Zip	:	00683-4074
Country	:	US
Telephone Number	:	787-892-1860
Fax Number	:	787-892-6972

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	01/21/2010

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