Provider Demographics
NPI:1043522063
Name:JOSE R ROVIRA MD PA
Entity type:Organization
Organization Name:JOSE R ROVIRA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROVIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-552-5354
Mailing Address - Street 1:PO BOX 565006
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33256-5006
Mailing Address - Country:US
Mailing Address - Phone:305-552-5354
Mailing Address - Fax:305-222-8444
Practice Address - Street 1:11760 SW 40 STREET
Practice Address - Street 2:SUITE 646
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-8101
Practice Address - Country:US
Practice Address - Phone:305-552-5354
Practice Address - Fax:305-222-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME25875174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065067600Medicaid
FL95530OtherBLUE SHIELD
FLD64806Medicare UPIN
FL065067600Medicaid