Healthcare Provider Details

I. General information

NPI: 1912943614
Provider Name (Legal Business Name): JUAN C ROMERO P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 11/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4218 E 4TH AVE
HIALEAH FL
33013-2306
US

IV. Provider business mailing address

8750 NW 36TH ST STE 300
DORAL FL
33178-2499
US

V. Phone/Fax

Practice location:
  • Phone: 305-266-2929
  • Fax: 786-558-9980
Mailing address:
  • Phone: 305-262-1610
  • Fax: 305-907-6099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101558
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: