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General NPI Number Information
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NPI Number | 1265663421
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Entity Type | Individual
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Provider Name | CARLOS LUIS ROMAN
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Gender | Male
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Dates
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Enumeration Date | 08/05/2009
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | PR-111 KM. 13.8
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City | SAN SEBASTIAN
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State | PR
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Zip | 00685
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Country | US
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Telephone | 787-280-6397
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Fax | 787-280-6397
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Provider Business Mailing Address
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Address Line | PO BOX 3691
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City | GUAYNABO
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State | PR
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Zip | 00970-3691
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Country | US
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Telephone | 787-381-5797
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Fax | 787-790-3973
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 17651
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License Number State | PR
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