Provider Demographics
NPI:1427047760
Name:BRIGNONI ROMAN, MANUEL A (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:A
Last Name:BRIGNONI 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:CALLE CONCODIA #8118
Mailing Address - Street 2:GALENA PROFESIONAL SUITE 105
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1589
Mailing Address - Country:US
Mailing Address - Phone:787-844-3067
Mailing Address - Fax:
Practice Address - Street 1:CALLE CONCODIA #8118
Practice Address - Street 2:GALENA PROFESIONAL SUITE 105
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1589
Practice Address - Country:US
Practice Address - Phone:787-844-3067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR99342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
88965BROtherSSS
060461OtherCHEZ AZUL
88965Medicare ID - Type Unspecified
88965BROtherSSS