Healthcare Provider Details

I. General information

NPI: 1578196903
Provider Name (Legal Business Name): CENTRO CLINICO VEGA ROMAN PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB EL RECREO 46 CALLE RAFAEL ROSARIO ARROYO
HUMACAO PR
00791
US

IV. Provider business mailing address

CIUDAD JARDIN URB LOS SUENOS 33 CALLE FANTASIA
GURABO PR
00778
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-1355
  • Fax: 787-266-9782
Mailing address:
  • Phone: 787-458-2419
  • Fax: 787-266-9782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LEYDA MELENY ROMAN NIEVES
Title or Position: PEDIATRA
Credential: MD
Phone: 787-458-2419