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General NPI Number Information
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NPI Number | 1104210145
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Entity Type | Organization
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Legal Business Name | DR.JUAN L.ROMERO BASSO CSP
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Dates
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Enumeration Date | 03/27/2015
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Last Update Date | 03/27/2015
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Provider Practice Location Address
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Address Line | 239 AVE ARTERIAL HOSTOS SUITE 806 CAPITAL CENTER SUR
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City | SAN JUAN
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State | PR
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Zip | 00918-1474
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Country | US
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Telephone | 787-766-1919
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Fax | 787-250-8156
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Provider Business Mailing Address
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Address Line | 239 AVE ARTERIAL HOSTOS SUITE 806 CAPITAL CENTER SUR
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City | SAN JUAN
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State | PR
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Zip | 00918-1474
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Country | US
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Telephone | 787-766-1919
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JUAN LUIS ROMERO
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Credential | M.D.
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Telephone | 787-766-1919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 9038
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License Number State | PR
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