Healthcare Provider Details

I. General information

NPI: 1013155175
Provider Name (Legal Business Name): GIORGIO ROVERAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26001 REDLANDS BLVD
REDLANDS CA
92373-7762
US

IV. Provider business mailing address

2045 COMPTON AVE STE 101
CORONA CA
92881-7286
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-7084
  • Fax: 909-894-7961
Mailing address:
  • Phone: 951-817-8820
  • Fax: 951-817-8856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA106675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: