Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 2854 | CA |
NPI | 1134502610 |
---|---|
Provider Name | Luis Roman SR. |
First Address | Ponce, PR 00717-0421 |
Second Address | Ponce, PR 00717-0421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2015 |
Last Update Date | 02/07/2015 |