Healthcare Provider Details

I. General information

NPI: 1578897401
Provider Name (Legal Business Name): ROVICA DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 CALLE MCKINLEY W STE 105
MAYAGUEZ PR
00680-3865
US

IV. Provider business mailing address

PO BOX 698
MAYAGUEZ PR
00681-0698
US

V. Phone/Fax

Practice location:
  • Phone: 787-832-8445
  • Fax: 787-805-7440
Mailing address:
  • Phone: 787-832-8445
  • Fax: 787-805-7440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number837
License Number StatePR

VIII. Authorized Official

Name: MR. CARLOS IVAN HUERTAS
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 787-832-8445