Healthcare Provider Details

I. General information

NPI: 1316181373
Provider Name (Legal Business Name): NELSON ROURA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 AVE DE HOSTOS
SAN JUAN PR
00918-3015
US

IV. Provider business mailing address

464 AVE DE HOSTOS
SAN JUAN PR
00918-3015
US

V. Phone/Fax

Practice location:
  • Phone: 787-756-6195
  • Fax: 787-767-2653
Mailing address:
  • Phone: 787-756-6195
  • Fax: 787-767-2653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number742
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: