Provider Demographics
NPI:1477246650
Name:ROMAN SIERRA, PEDRO IVAN (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:IVAN
Last Name:ROMAN SIERRA
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:HC 6 BOX 61090
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-9369
Mailing Address - Country:US
Mailing Address - Phone:939-429-2164
Mailing Address - Fax:
Practice Address - Street 1:63 AVE MUNOZ RIVERA E
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-2630
Practice Address - Country:US
Practice Address - Phone:787-898-2660
Practice Address - Fax:787-262-1210
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23645208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice