1417190067 NPI number — DR. LUIS M ROMAN-BADENAS

Table of content: DR. LUIS M ROMAN-BADENAS (NPI 1417190067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417190067 NPI number — DR. LUIS M ROMAN-BADENAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMAN-BADENAS
Provider First Name:
LUIS
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417190067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1025
Provider Second Line Business Mailing Address:
PMB 336
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726-1025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-745-0340
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE. HOSTOS 770 CARR. # 2
Provider Second Line Business Practice Location Address:
POLICLINICA BELLA VISTA
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-986-0023
Provider Business Practice Location Address Fax Number:
787-833-3831
Provider Enumeration Date:
04/13/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  3039 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)