Edgardo Roman

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

5715 Issued in PR

Legal business name

EDGARDO ROMAN

Practice address

10 Dr Alvarez Chanca Street
Esq Ave Sabana Seca
Toa Baja, PR 00949

Phone

(787) 995-4912

Fax

(787) 261-3113

NPI assigned

Dec 21, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Brenda Liz Vazquez Bolorin, MT

Title

Medical Tecnologist

Phone

(787) 261-3100

Specialties & licenses 1

Addresses

Other names 1

• Laboratorio Clinico Lagos de Plata Doing business as

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

Tax ID family

Edgardo Roman2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Laboratorio Clinico Lagos de Plata 2

  • Clinical Medical Laboratory
  • Guaynabo, PR
  • NPI 1396175840
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423440000000",
    "number": "1164586483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "M5 QUINTAS DEL RIO",
            "address_2": "CAMINO DEL HOSTAL",
            "city": "BAYAMON",
            "state": "PR",
            "postal_code": "00961",
            "telephone_number": "787-261-3100",
            "fax_number": "787-261-3113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 DR ALVAREZ CHANCA STREET",
            "address_2": "ESQ AVE SABANA SECA",
            "city": "TOA BAJA",
            "state": "PR",
            "postal_code": "00949",
            "telephone_number": "787-995-4912",
            "fax_number": "787-261-3113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGARDO ROMAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2015-02-09",
        "status": "A",
        "authorized_official_last_name": "VAZQUEZ BOLORIN",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "LIZ",
        "authorized_official_title_or_position": "MEDICAL TECNOLOGIST",
        "authorized_official_telephone_number": "787-261-3100",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MT"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PR",
            "license": "5715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laboratorio Clinico Lagos de Plata",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Medical Laboratory in Toa Baja, PR
• Providers in Toa Baja, PR by specialty
• Clinical Medical Laboratory in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.