| Ricardo Roman Md Inc | |
|
4708 Eagle Rock Blvd Eagle Rock CA 90041-2712 | |
| (323) 254-3701 | |
| Not Available |
| Full Name | Ricardo Roman Md Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4708 Eagle Rock Blvd, Eagle Rock, California |
| Authorized Official Name and Position | Ricardo Roman (CEO) |
| Authorized Official Contact | 3232543701 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ricardo Roman Md Inc 4708 Eagle Rock Blvd Eagle Rock CA 90041-2712 Ph: (323) 254-3701 | Ricardo Roman Md Inc 4708 Eagle Rock Blvd Eagle Rock CA 90041-2712 Ph: (323) 254-3701 |
| NPI Number | 1831462712 |
|---|---|
| Provider Enumeration Date | 02/22/2012 |
| Last Update Date | 04/04/2012 |
| Medicare PECOS PAC ID | 2365606035 |
|---|---|
| Medicare Enrollment ID | O20120608000028 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831462712 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Ricardo Roman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144327032 PECOS PAC ID: 7719927045 Enrollment ID: I20050505001173 |
Jaga Medical Group Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1400 Colorado Blvd, A, Eagle Rock, CA 90041 Phone: 323-999-2250 Fax: 323-999-2241 |