Provider Demographics
NPI:1255593166
Name:PEDRO ROMAGUERA, APMC
Entity type:Organization
Organization Name:PEDRO ROMAGUERA, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:PATRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-779-3507
Mailing Address - Street 1:3901 HOUMA BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2930
Mailing Address - Country:US
Mailing Address - Phone:504-779-3507
Mailing Address - Fax:504-779-3508
Practice Address - Street 1:3901 HOUMA BLVD STE 108
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2930
Practice Address - Country:US
Practice Address - Phone:504-779-3507
Practice Address - Fax:504-779-3508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09148R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1932523Medicaid