Individual
ROMEO GONZAGA ICASIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
947 SO 5TH ST, MONTROSE, CO 81401-5716
(870) 249-2421
(970) 249-8897
Mailing address
947 SO 5TH ST, MONTROSE, CO 81401-5716
(870) 249-2421
(970) 249-8897
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
37326
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01373265
—
CO
Enumeration date
08/02/2005
Last updated
04/10/2012
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