Provider Demographics
NPI:1851506414
Name:ROURA-ORTIZ, EUGENIO ENRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:EUGENIO
Middle Name:ENRIQUE
Last Name:ROURA-ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:H9 CALLE ALEGRIA
Mailing Address - Street 2:URB. HORIZONTES
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-4039
Mailing Address - Country:US
Mailing Address - Phone:787-645-4100
Mailing Address - Fax:787-790-6339
Practice Address - Street 1:H9 CALLE ALEGRIA
Practice Address - Street 2:URB. HORIZONTES
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-645-4100
Practice Address - Fax:787-790-6339
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6173208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice