Provider Demographics
NPI:1881636710
Name:ROMERO-BASSO, JUAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:L
Last Name:ROMERO-BASSO
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 1:239 ARTERIAL HOSTOS SUITE 806
Mailing Address - Street 2:CAPITAL CENTER SUR
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1474
Mailing Address - Country:US
Mailing Address - Phone:787-766-1919
Mailing Address - Fax:787-250-8156
Practice Address - Street 1:239 ARTERIAL HOSTOS SUITE 806
Practice Address - Street 2:CAPITAL CENTER SUR
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918-1476
Practice Address - Country:US
Practice Address - Phone:787-766-1919
Practice Address - Fax:787-250-8156
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9038174400000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist