Provider Demographics
NPI:1356621759
Name:ROMAN REPUBLIC CORPORATION
Entity type:Organization
Organization Name:ROMAN REPUBLIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:GONZALEZ
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-780-8427
Mailing Address - Street 1:601C E PALOMAR ST # 131
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6974
Mailing Address - Country:US
Mailing Address - Phone:619-780-8427
Mailing Address - Fax:619-308-6927
Practice Address - Street 1:1455 VENTERS DR
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6910
Practice Address - Country:US
Practice Address - Phone:619-397-0599
Practice Address - Fax:619-308-6927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health