Provider Demographics
NPI:1518978501
Name:ROIG, ENRIQUE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:
Last Name:ROIG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3659 S MIAMI AVE
Mailing Address - Street 2:STE. 4008
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4227
Mailing Address - Country:US
Mailing Address - Phone:305-285-5085
Mailing Address - Fax:305-285-5084
Practice Address - Street 1:3659 S MIAMI AVE
Practice Address - Street 2:STE. 4008
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4227
Practice Address - Country:US
Practice Address - Phone:305-285-5085
Practice Address - Fax:305-285-5084
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100664363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291055100Medicaid
FL291055100Medicaid
FLP36399Medicare UPIN