Healthcare Provider Details

I. General information

NPI: 1568430551
Provider Name (Legal Business Name): JOSE M ROVIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE LUIS MUNOZ MARIN #2
HORMIGUEROS PR
00660
US

IV. Provider business mailing address

PO BOX 1520
HORMIGUEROS PR
00660
US

V. Phone/Fax

Practice location:
  • Phone: 787-849-0111
  • Fax: 787-849-0707
Mailing address:
  • Phone: 787-849-0111
  • Fax: 787-849-0707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number9796
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: