Provider Demographics
NPI:1528469921
Name:ROMA OBGYN SERVICES, P.S.C.
Entity type:Organization
Organization Name:ROMA OBGYN SERVICES, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-640-4518
Mailing Address - Street 1:PO BOX 75
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-0075
Mailing Address - Country:US
Mailing Address - Phone:787-640-4518
Mailing Address - Fax:
Practice Address - Street 1:63 MENDEZ VIGO E
Practice Address - Street 2:SUITE 3A CONDOMINIO CENTRO PLAZA
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4972
Practice Address - Country:US
Practice Address - Phone:787-831-4320
Practice Address - Fax:787-831-4320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18586207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty