Healthcare Provider Details

I. General information

NPI: 1598103913
Provider Name (Legal Business Name): ROMAN GABRIEL GUERRERO-MAESTRE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15700 37TH AVE N STE 150
PLYMOUTH MN
55446-3675
US

IV. Provider business mailing address

15700 37TH AVE N STE 150
PLYMOUTH MN
55446-3675
US

V. Phone/Fax

Practice location:
  • Phone: 651-968-5201
  • Fax:
Mailing address:
  • Phone: 651-968-5201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number63761
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number63761
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: