Healthcare Provider Details

I. General information

NPI: 1518542802
Provider Name (Legal Business Name): JULIA M ROVERA RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NAUDAIN ST
PHILADELPHIA PA
19147-2406
US

IV. Provider business mailing address

111 NAUDAIN ST
PHILADELPHIA PA
19147-2406
US

V. Phone/Fax

Practice location:
  • Phone: 610-203-7036
  • Fax:
Mailing address:
  • Phone: 610-203-7036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN007136
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: