Healthcare Provider Details

I. General information

NPI: 1346560778
Provider Name (Legal Business Name): XAVIER ROMAN-HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 CELEBRATION PL FL 2
CELEBRATION FL
34747-4606
US

IV. Provider business mailing address

380 CELEBRATION PL FL 2
CELEBRATION FL
34747-4606
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-4220
  • Fax: 407-303-4676
Mailing address:
  • Phone: 407-303-4220
  • Fax: 407-303-4676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME116992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: