Provider Demographics
NPI:1578196903
Name:CENTRO CLINICO VEGA ROMAN PSC
Entity Type:Organization
Organization Name:CENTRO CLINICO VEGA ROMAN PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRA
Authorized Official - Prefix:DR
Authorized Official - First Name:LEYDA
Authorized Official - Middle Name:MELENY
Authorized Official - Last Name:ROMAN NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-458-2419
Mailing Address - Street 1:CIUDAD JARDIN URB LOS SUENOS
Mailing Address - Street 2:33 CALLE FANTASIA
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-458-2419
Mailing Address - Fax:787-266-9782
Practice Address - Street 1:URB EL RECREO
Practice Address - Street 2:46 CALLE RAFAEL ROSARIO ARROYO
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-1355
Practice Address - Fax:787-266-9782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty