Healthcare Provider Details

I. General information

NPI: 1538357066
Provider Name (Legal Business Name): DR. ROBERTO ROMAN ROMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 05/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA CARIBBEAN HEALTH CARE SYSTEM 10 CALLE CASIA
SAN JUAN PR
00921-3201
US

IV. Provider business mailing address

VISTAS DEL ATLANTICO 118
ARECIBO PR
00612
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax:
Mailing address:
  • Phone: 787-751-3454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number649
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: