Healthcare Provider Details

I. General information

NPI: 1689480360
Provider Name (Legal Business Name): CAROLINA E ROVIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 GROVEDALE DR STE 200
ALEXANDRIA VA
22310-2504
US

IV. Provider business mailing address

2216 CASTLE ROCK SQ APT 12C
RESTON VA
20191-6021
US

V. Phone/Fax

Practice location:
  • Phone: 571-414-9645
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0704037153
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: