Provider Demographics
NPI:1184853756
Name:ROMAN-RUPERTO, EDNISE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDNISE
Middle Name:MARIE
Last Name:ROMAN-RUPERTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 VIA DESTELLO
Mailing Address - Street 2:HACIENDA SAN JOSE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3109
Mailing Address - Country:US
Mailing Address - Phone:787-981-4406
Mailing Address - Fax:
Practice Address - Street 1:282 CALLE JACARANDA
Practice Address - Street 2:PASEO DE LA CEIBA
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-7423
Practice Address - Country:US
Practice Address - Phone:787-981-4406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-05
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18476207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology