Healthcare Provider Details

I. General information

NPI: 1184675688
Provider Name (Legal Business Name): MICHAEL ANTHONY ROVZAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 05/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30230 RANCHO VIEJO RD SUITE 200
SAN JUAN CAPISTRANO CA
92675-1557
US

IV. Provider business mailing address

PO BOX 7087
ORANGE CA
92863-7087
US

V. Phone/Fax

Practice location:
  • Phone: 949-443-4303
  • Fax: 949-443-4033
Mailing address:
  • Phone: 714-571-5000
  • Fax: 714-571-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG53398
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG53398
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG53398
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: