Healthcare Provider Details

I. General information

NPI: 1831645506
Provider Name (Legal Business Name): OMAR JOSE ROVIRA BELLIDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 AVE HOSTOS
MAYAGUEZ PR
00682-1560
US

IV. Provider business mailing address

PO BOX 3627
MAYAGUEZ PR
00681-3627
US

V. Phone/Fax

Practice location:
  • Phone: 787-652-9200
  • Fax:
Mailing address:
  • Phone: 787-475-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number22436
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: