Healthcare Provider Details

I. General information

NPI: 1861447922
Provider Name (Legal Business Name): EDWIN ROVIRA-IRIZARRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MENDEZ VIGO 63 E CENTRO PLAZA 3A
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

PO BOX 958
MAYAGUEZ PR
00681-0958
US

V. Phone/Fax

Practice location:
  • Phone: 787-831-4320
  • Fax: 787-831-4320
Mailing address:
  • Phone: 787-831-4320
  • Fax: 787-831-4320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number4811
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: