Healthcare Provider Details

I. General information

NPI: 1780658468
Provider Name (Legal Business Name): MIGUEL JOSE ROVIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LONGWOOD AVE
ROCKLEDGE FL
32955-2828
US

IV. Provider business mailing address

1 PISCES LN
ROCKLEDGE FL
32955-5742
US

V. Phone/Fax

Practice location:
  • Phone: 321-636-2211
  • Fax:
Mailing address:
  • Phone: 321-536-7835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberME55001
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberME55001
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number55001
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: