Healthcare Provider Details

I. General information

NPI: 1720088057
Provider Name (Legal Business Name): MICHAEL BABILONIA ROMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. LOS CORAZONES, EDIFICIO MEDICO PROFESIONAL #1065 SUITE 212
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

AVE. LOS CORAZONES, EDIFICIO MEDICO PROFESIONAL #1065 SUITE 212
MAYAGUEZ PR
00680
US

V. Phone/Fax

Practice location:
  • Phone: 787-834-1964
  • Fax: 787-831-2224
Mailing address:
  • Phone: 787-834-1964
  • Fax: 787-831-2224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number10534
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: