Provider Demographics
NPI:1073712667
Name:CLINICA DR ROVIRA
Entity Type:Organization
Organization Name:CLINICA DR ROVIRA
Other - Org Name:SERVICIOS MEDICOS HORMIGUEROS, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROVIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-849-0111
Mailing Address - Street 1:PO BOX 1520
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-1520
Mailing Address - Country:US
Mailing Address - Phone:787-849-0111
Mailing Address - Fax:787-849-0707
Practice Address - Street 1:2 CALLE LUIS MUNOZ MARIN
Practice Address - Street 2:
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660-1737
Practice Address - Country:US
Practice Address - Phone:787-849-0111
Practice Address - Fax:787-849-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR44261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81089OtherTRIPLE S, INC
PR30-0094-3OtherACAA
PR30-0094-3OtherACAA