Provider Demographics
NPI:1770666273
Name:DRA GRACE MARINI ROMAN CARDIOLOGA
Entity Type:Organization
Organization Name:DRA GRACE MARINI ROMAN CARDIOLOGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINI ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-833-3349
Mailing Address - Street 1:6 MOREL CAMPOS
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-833-3349
Mailing Address - Fax:787-805-2244
Practice Address - Street 1:6 MOREL CAMPOS
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-833-3349
Practice Address - Fax:787-805-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9032207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC77772Medicare UPIN
PR80683Medicare PIN