Healthcare Provider Details

I. General information

NPI: 1275194433
Provider Name (Legal Business Name): MAIRYM DELGADO ROMAN P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 F. D. ROOSEVELT AVE SUITE 506
HATO REY PR
00918
US

IV. Provider business mailing address

22 AVE SAN IGNACIO APT 302
GUAYNABO PR
00969-4306
US

V. Phone/Fax

Practice location:
  • Phone: 787-250-7841
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MAIRYM DELGADO ROMAN
Title or Position: PRESIDENT
Credential: DMD
Phone: 787-354-9186