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General NPI Number Information
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NPI Number | 1184853756
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Entity Type | Individual
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Provider Name | EDNISE MARIE ROMAN-RUPERTO M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/05/2009
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 282 CALLE JACARANDA PASEO DE LA CEIBA
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City | JUNCOS
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State | PR
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Zip | 00777-7423
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Country | US
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Telephone | 787-981-4406
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Fax |
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Provider Business Mailing Address
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Address Line | 660 VIA DESTELLO HACIENDA SAN JOSE
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City | CAGUAS
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State | PR
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Zip | 00727-3109
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Country | US
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Telephone | 787-981-4406
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 18476
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License Number State | PR
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