Provider Demographics
NPI:1336203090
Name:JUSINO ROMAN, ERNESTO LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:LUIS
Last Name:JUSINO ROMAN
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:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0066
Mailing Address - Country:US
Mailing Address - Phone:787-892-6972
Mailing Address - Fax:787-892-6972
Practice Address - Street 1:2 CALLE CARRO
Practice Address - Street 2:HOSPITAL DE LA CONCEPCION 2ND FLOOR
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4074
Practice Address - Country:US
Practice Address - Phone:787-892-1860
Practice Address - Fax:787-892-6972
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13524207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H84376Medicare UPIN