Provider Demographics
NPI:1386070043
Name:DRA. ROSA I. ROMAN CARLO, C.S.P.
Entity type:Organization
Organization Name:DRA. ROSA I. ROMAN CARLO, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE PULMONARY
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:I
Authorized Official - Last Name:ROMAN CARLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-467-6080
Mailing Address - Street 1:55 CALLE DR BASORA N
Mailing Address - Street 2:EDIF MEDICO IV OFICINA 210
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4810
Mailing Address - Country:US
Mailing Address - Phone:787-210-1102
Mailing Address - Fax:
Practice Address - Street 1:55 CALLE DR BASORA N
Practice Address - Street 2:EDIF MEDICO IV OFICINA 210
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4810
Practice Address - Country:US
Practice Address - Phone:787-210-1102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9009207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
82453OtherMEDICARE
82453OtherMEDICARE