Healthcare Provider Details

I. General information

NPI: 1710705330
Provider Name (Legal Business Name): ROBERT JULIAN ROVIRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S FREMONT AVE UNIT 7, BLD A10, N10100
ALHAMBRA CA
91803-8897
US

IV. Provider business mailing address

513 GRISWOLD ST APT 1
GLENDALE CA
91205-1997
US

V. Phone/Fax

Practice location:
  • Phone: 626-457-4240
  • Fax: 626-457-4245
Mailing address:
  • Phone: 818-391-9851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: