Provider Demographics
NPI:1528148079
Name:FORTIN-MAGANA, ROMEO (MD)
Entity type:Individual
Prefix:MR
First Name:ROMEO
Middle Name:
Last Name:FORTIN-MAGANA
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 36765
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77236-6765
Mailing Address - Country:US
Mailing Address - Phone:713-988-3027
Mailing Address - Fax:713-988-3027
Practice Address - Street 1:6655 HILLCROFT
Practice Address - Street 2:#109
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081
Practice Address - Country:US
Practice Address - Phone:713-988-3027
Practice Address - Fax:713-988-3027
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9436208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
B22759Medicare UPIN
TXRC27Medicare ID - Type Unspecified