Healthcare Provider Details

I. General information

NPI: 1679711378
Provider Name (Legal Business Name): ROVICO HEALTHCARE ADMINISTRATIVE AND CONSULTING SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE SEVERIANO CUEVAS CARR #2 KM 141.1
AGUADILLA PR
00603-0000
US

IV. Provider business mailing address

PO BOX 880
MAYAGUEZ PR
00681-0880
US

V. Phone/Fax

Practice location:
  • Phone: 787-882-1835
  • Fax: 787-882-2659
Mailing address:
  • Phone: 787-806-1835
  • Fax: 787-986-1835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberCASM0426
License Number StatePR

VIII. Authorized Official

Name: MS. RUTH M ORTIZ
Title or Position: PRESIDENT GOVERNING BOARD
Credential: MHSA
Phone: 787-806-1835