Provider Demographics
NPI:1063452688
Name:ROMAN, LUIS ALEXIS (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ALEXIS
Last Name:ROMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB PASEO ALTO
Mailing Address - Street 2:CALLE 2 NUM 40
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-296-0617
Mailing Address - Fax:
Practice Address - Street 1:URB LA MERCED
Practice Address - Street 2:CABO H ALVERIO 574
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-296-0617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12650207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0089851Medicare ID - Type UnspecifiedMEDICARE