Provider Demographics
NPI:1417190067
Name:ROMAN-BADENAS, LUIS M
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:M
Last Name:ROMAN-BADENAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1025
Mailing Address - Street 2:PMB 336
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1025
Mailing Address - Country:US
Mailing Address - Phone:787-745-0340
Mailing Address - Fax:
Practice Address - Street 1:AVE. HOSTOS 770 CARR. # 2
Practice Address - Street 2:POLICLINICA BELLA VISTA
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-986-0023
Practice Address - Fax:787-833-3831
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3039103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical