| Provider / Organization | NPI | Date Certified |
|---|---|---|
| ROMAN CRIOLLO | 1699834408 | 2023-11-11 |
Roman Criollo is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1699834408. Registration indicates Roman Criollo is a provider of access to pediatric primary care providers services with a specialization in Allopathic & Osteopathic Physicians, Pediatrics (Allopathic & Osteopathic Physicians, Pediatrics) (Pediatrics, ) (Primary Care/Family Planning/APRN/PA, ) (Pediatrics, Allopathic & Osteopathic Physicians) Access to Pediatric Primary Care Providers (Allopathic & Osteopathic Physicians, Pediatrics) (Allopathic & Osteopathic Physicians, Pediatrics) (Pediatrics, ) (Primary Care/Family Planning/APRN/PA, ) (Pediatrics, Allopathic & Osteopathic Physicians)
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Roman Criollo M.D |
| Practice Office Address | 1680 DUNN AVE JACKSONVILLE, FL US |
| Practice Office Telephone | 9047604904 |
| Mailing Address | 1680 DUNN AVE UNIT 35-37 JACKSONVILLE, FL 322184782 US |
| Business Telephone | 9047604904 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 1680 Dunn Ave Ste 35 | Jacksonville, FL 322184744 | 9047604904 |
| 3900-2 University Blvd | Jacksonville, FL 322443224 | 9047604904 |
| 120 King St | Jacksonville, FL 322042410 | 9047604904 |
| 6024 Merrill Rd | Jacksonville, FL 322773427 | 9047604904 |
| 1880 Edgewood Ave W | Jacksonville, FL 322083021 | 9047604904 |
| 5460 Blanding Blvd | Jacksonville, FL 322441957 | 9047604904 |
| 10365 Hood Rd S Ste 204 | Jacksonville, FL 322573261 | 9047387045 / 9047387678 |
| Code | Practice | License No State |
|---|---|---|
| 208000000X | Access to Pediatric Primary Care Providers Allopathic & Osteopathic Physicians Pediatrics Allopathic & Osteopathic Physicians Pediatrics Pediatrics Primary Care/Family Planning/APRN/PA Pediatrics Allopathic & Osteopathic Physicians | 38184
AZ |
| 208000000X PRIMARY | Access to Pediatric Primary Care Providers Allopathic & Osteopathic Physicians Pediatrics Allopathic & Osteopathic Physicians Pediatrics Pediatrics Primary Care/Family Planning/APRN/PA Pediatrics Allopathic & Osteopathic Physicians | ME137455
FL |
| 101870300 | MEDICAID | FL | |
| 118398900 | MEDICAID | FL |