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General NPI Number Information
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NPI Number | 1578196903
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Entity Type | Organization
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Legal Business Name | CENTRO CLINICO VEGA ROMAN PSC
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Dates
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Enumeration Date | 02/13/2020
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Last Update Date | 02/13/2020
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Provider Practice Location Address
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Address Line | URB EL RECREO 46 CALLE RAFAEL ROSARIO ARROYO
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City | HUMACAO
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State | PR
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Zip | 00791
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Country | US
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Telephone | 787-852-1355
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Fax | 787-266-9782
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Provider Business Mailing Address
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Address Line | CIUDAD JARDIN URB LOS SUENOS 33 CALLE FANTASIA
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City | GURABO
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State | PR
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Zip | 00778
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Country | US
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Telephone | 787-458-2419
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Fax | 787-266-9782
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Authorized Official
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Title or Position | PEDIATRA
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Name | DR. LEYDA MELENY ROMAN NIEVES
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Credential | MD
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Telephone | 787-458-2419
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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