Healthcare Provider Details

I. General information

NPI: 1568455905
Provider Name (Legal Business Name): MARCUS R. ROVIRA N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 SAINT CLAIR BLVD
GONZALES LA
70737
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-5500
  • Fax: 225-765-9196
Mailing address:
  • Phone: 225-765-5500
  • Fax: 225-765-6916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2810
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number02810
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: