Provider Demographics
NPI:1669924304
Name:ROMAN REPUBLIC CORPORATION
Entity type:Organization
Organization Name:ROMAN REPUBLIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ELVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-421-2997
Mailing Address - Street 1:601C E PALOMAR ST
Mailing Address - Street 2:SUITE 131
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6976
Mailing Address - Country:US
Mailing Address - Phone:619-421-2997
Mailing Address - Fax:619-308-6927
Practice Address - Street 1:601C E PALOMAR ST
Practice Address - Street 2:SUITE 131
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6976
Practice Address - Country:US
Practice Address - Phone:619-421-2997
Practice Address - Fax:619-308-6927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care