1386638435 NPI number — JOSE R ROVIRA MD

Table of content: JOSE R ROVIRA MD (NPI 1386638435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386638435 NPI number — JOSE R ROVIRA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROVIRA
Provider First Name:
JOSE
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386638435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 565006
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33256-5006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-552-5354
Provider Business Mailing Address Fax Number:
305-222-8444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11760 SW 40TH ST
Provider Second Line Business Practice Location Address:
SUITE 646
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33175-3582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-552-5354
Provider Business Practice Location Address Fax Number:
305-222-8444
Provider Enumeration Date:
09/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  ME25875 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ME0025875 . This is a "WORK/COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60003194 . This is a "RAILROAD MEDICAID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 95530 . This is a "BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: D64806 . This is a "VISTA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 52081 . This is a "JMH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 209132 . This is a "AVMED" identifier . This identifiers is of the category "OTHER".




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