Healthcare Provider Details

I. General information

NPI: 1285818385
Provider Name (Legal Business Name): ROMAN UROLOGY GROUP PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 AVE HOSTOS
MAYAGUEZ PR
00682-1538
US

IV. Provider business mailing address

PO BOX 1230
MAYAGUEZ PR
00681-1230
US

V. Phone/Fax

Practice location:
  • Phone: 787-834-8160
  • Fax: 787-265-5777
Mailing address:
  • Phone: 787-834-8160
  • Fax: 787-265-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number14210
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number18018
License Number StatePR

VIII. Authorized Official

Name: WILLIAM ROMAN-TORREGUITART
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-834-8160