1053677351 NPI number — FEDERICO ROMAN NG, MDPA

Table of content: (NPI 1053677351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053677351 NPI number — FEDERICO ROMAN NG, MDPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FEDERICO ROMAN NG, MDPA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1053677351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7922 EWING HALSELL DR
Provider Second Line Business Mailing Address:
SUITE 270
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-3786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-614-2828
Provider Business Mailing Address Fax Number:
210-614-2558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7922 EWING HALSELL DR
Provider Second Line Business Practice Location Address:
SUITE 270
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-3786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-614-2828
Provider Business Practice Location Address Fax Number:
210-614-2558
Provider Enumeration Date:
04/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
NG
Authorized Official First Name:
FEDERICO
Authorized Official Middle Name:
ROMAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
210-614-2828

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  J6623 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1528061488 . This is a "NPI-INDIVIDUAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com