Provider Demographics
NPI:1285710251
Name:ROMAN, JUAN M (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:M
Last Name: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 633
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-0633
Mailing Address - Country:US
Mailing Address - Phone:787-484-4545
Mailing Address - Fax:
Practice Address - Street 1:AVE SABANA SECA CARR 867 KM 2.2
Practice Address - Street 2:TOA BAJA HEALTH CENTER
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00952-0000
Practice Address - Country:US
Practice Address - Phone:787-261-3260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12223208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH55611Medicare UPIN
PR0089852Medicare PIN