MEDICARE: NELSON ROURA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	742	PR

General Provider Information

NPI Number	:	1316181373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NELSON ROURA

Provider Business Mailing Address
First Line	:	464 AVE DE HOSTOS
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3015
Country	:	US
Telephone Number	:	787-756-6195
Fax Number	:	787-767-2653

Provider Business Practice Location Address
First Line	:	464 AVE DE HOSTOS
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3015
Country	:	US
Telephone Number	:	787-756-6195
Fax Number	:	787-767-2653

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2009
Last Update Date	:	04/21/2009

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Directions to “ NELSON ROURA ” Practice Location

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