Healthcare Provider Details

I. General information

NPI: 1457557225
Provider Name (Legal Business Name): MADELYN ROVIRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 CALLE FALCON MONTEHIEDRA
SAN JUAN PR
00926-9536
US

IV. Provider business mailing address

65 CALLE FALCON MONTEHIEDRA
SAN JUAN PR
00926-9536
US

V. Phone/Fax

Practice location:
  • Phone: 787-272-2230
  • Fax:
Mailing address:
  • Phone: 787-272-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number12881
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: