Basic Information
| Provider Information | |||||||||
| NPI: | 1699964692 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHAEL H ROMAGUERA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11055 SHOE CREEK DR | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708184022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252614493 | ||||||||
| FaxNumber: | 2252618416 | ||||||||
| Practice Location | |||||||||
| Address1: | 11055 SHOE CREEK DR | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708184022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252614493 | ||||||||
| FaxNumber: | 2252618416 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2007 | ||||||||
| LastUpdateDate: | 08/06/2008 | ||||||||
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| AuthorizedOfficialLastName: | BEAUREGARD | ||||||||
| AuthorizedOfficialFirstName: | CRISTEN | ||||||||
| AuthorizedOfficialMiddleName: | CLAIRE | ||||||||
| AuthorizedOfficialTitleorPosition: | INSURANCE COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 2252614493 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 017750 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1942189 | 05 | LA | MEDICAID | 1348091 | 05 | LA | MEDICAID | 930114662 | 01 | LA | RRM LAKE AFTER HOURS | OTHER |