Healthcare Provider Details

I. General information

NPI: 1518978501
Provider Name (Legal Business Name): ENRIQUE ROIG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3659 S MIAMI AVE STE. 4008
MIAMI FL
33133-4227
US

IV. Provider business mailing address

3659 S MIAMI AVE STE. 4008
MIAMI FL
33133-4227
US

V. Phone/Fax

Practice location:
  • Phone: 305-285-5085
  • Fax: 305-285-5084
Mailing address:
  • Phone: 305-285-5085
  • Fax: 305-285-5084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9100664
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: