Provider Demographics
NPI:1417926841
Name:ROMERO-BOLUMEN, ILEANA (MD)
Entity Type:Individual
Prefix:DR
First Name:ILEANA
Middle Name:
Last Name:ROMERO-BOLUMEN
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 1:1000 NW 57TH CT STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3284
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1225 NW 40TH AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-5801
Practice Address - Country:US
Practice Address - Phone:954-615-0900
Practice Address - Fax:954-615-0901
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059735208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0531162-00Medicaid
FL12423Medicare ID - Type Unspecified
FL0531162-00Medicaid