Healthcare Provider Details

I. General information

NPI: 1386638435
Provider Name (Legal Business Name): JOSE R ROVIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11760 SW 40TH ST SUITE 646
MIAMI FL
33175-3582
US

IV. Provider business mailing address

PO BOX 565006
MIAMI FL
33256-5006
US

V. Phone/Fax

Practice location:
  • Phone: 305-552-5354
  • Fax: 305-222-8444
Mailing address:
  • Phone: 305-552-5354
  • Fax: 305-222-8444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME25875
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: