Provider Demographics
NPI:1508937368
Name:ROMAN, MARIO LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:LUIS
Last Name:ROMAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2027 CALLE LUIS XIV
Mailing Address - Street 2:URB. LOS VERSALLES
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-7845
Mailing Address - Country:US
Mailing Address - Phone:787-832-1289
Mailing Address - Fax:787-832-1289
Practice Address - Street 1:CARR. 2 KM 141.7 BO. CAIMAITAL BAJO
Practice Address - Street 2:HOSPITAL BUEN SAMARITANO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605
Practice Address - Country:US
Practice Address - Phone:787-819-1010
Practice Address - Fax:787-819-1012
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PR12763207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine