Provider Demographics
NPI:1851332803
Name:SZKOPIEC, ROMAN LUBOMIER (MD)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:LUBOMIER
Last Name:SZKOPIEC
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 1:480 4TH AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4410
Mailing Address - Country:US
Mailing Address - Phone:619-427-8646
Mailing Address - Fax:619-425-7128
Practice Address - Street 1:480 4TH AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4410
Practice Address - Country:US
Practice Address - Phone:619-427-8646
Practice Address - Fax:619-425-7128
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37537207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A375370Medicaid
CAA37537Medicare ID - Type Unspecified
CAB26823Medicare UPIN