Healthcare Provider Details

I. General information

NPI: 1487102125
Provider Name (Legal Business Name): ACOSTA ROMAN CONSULTING GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 CALLE A URB LOS VETERANOS
SAN JUAN PR
00926
US

IV. Provider business mailing address

PO BOX 1250
TRUJILLO ALTO PR
00977
US

V. Phone/Fax

Practice location:
  • Phone: 939-337-6900
  • Fax:
Mailing address:
  • Phone: 939-337-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MELVIN ACOSTA-ROMAN
Title or Position: PRESIDENT
Credential: MHSA
Phone: 939-337-6900