Healthcare Provider Details

I. General information

NPI: 1417961541
Provider Name (Legal Business Name): JUAN JOSE ROVIRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W 20TH AVE SUITE 404
HIALEAH FL
33016-1897
US

IV. Provider business mailing address

7100 W 20TH AVE SUITE 404
HIALEAH FL
33016-1897
US

V. Phone/Fax

Practice location:
  • Phone: 305-362-8180
  • Fax: 305-362-7264
Mailing address:
  • Phone: 305-362-8180
  • Fax: 305-362-7264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME0043504
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: