Healthcare Provider Details

I. General information

NPI: 1679639785
Provider Name (Legal Business Name): MIGUEL A. ROMAN-DIAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. MIGUEL A. ROMAN-DIAZ

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 CALLE ALAMEDA VILLA GRANADA
SAN JUAN PR
00923-2719
US

IV. Provider business mailing address

909 CALLE ALAMEDA VILLA GRANADA
SAN JUAN PR
00923-2719
US

V. Phone/Fax

Practice location:
  • Phone: 787-755-7171
  • Fax: 787-625-3227
Mailing address:
  • Phone: 787-688-2779
  • Fax: 787-625-3227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number9028
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: