Healthcare Provider Details

I. General information

NPI: 1699820431
Provider Name (Legal Business Name): CARLOS ALBERTO LUCIANO-ROMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AVE FD ROOSEVELT SUITE 402
SAN JUAN PR
00918-2103
US

IV. Provider business mailing address

400 ROOSEVELT AVE SUITE 402 CLINICA LAS AMERICAS
SAN JUAN PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-2248
  • Fax: 787-766-3219
Mailing address:
  • Phone: 787-767-2248
  • Fax: 787-766-3319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number12867
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number12867
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: