Provider Demographics
NPI:1700111762
Name:ROMVACCINE INC
Entity Type:Organization
Organization Name:ROMVACCINE INC
Other - Org Name:PASSPORT HEALTH MIAMI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZDIRCU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-642-9889
Mailing Address - Street 1:782 NW 42ND AVE
Mailing Address - Street 2:STE. 629
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5541
Mailing Address - Country:US
Mailing Address - Phone:305-642-9889
Mailing Address - Fax:305-442-6036
Practice Address - Street 1:782 NW 42ND AVE
Practice Address - Street 2:STE. 629
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5541
Practice Address - Country:US
Practice Address - Phone:305-642-9889
Practice Address - Fax:305-442-6036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME079041261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center