Provider Demographics
NPI:1851499610
Name:ROMAN-FELICIANO, JUAN C SR (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:C
Last Name:ROMAN-FELICIANO
Suffix:SR
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:URB VILLA INTERAMERICANA CALLE-5 C-10
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683
Mailing Address - Country:US
Mailing Address - Phone:787-873-2285
Mailing Address - Fax:787-873-2285
Practice Address - Street 1:36 CALLE FRANCISCO M QUINONEZ
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-1941
Practice Address - Country:US
Practice Address - Phone:787-873-2285
Practice Address - Fax:787-804-0140
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5570207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
027083-ROOtherSSS
2-5570OtherMCS
068753OtherCRUZ AZUL
PE0909OtherPALIC
2208OtherIMC
4305570OtherUIA
212278OtherUTI
027083-ROOtherSSS
PE0909OtherPALIC