Provider Demographics
NPI:1992003750
Name:ROVIRA, MICHELLE
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:
Last Name:ROVIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:RAUL
Other - Middle Name:
Other - Last Name:OLIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9894 NW 82ND AVE
Mailing Address - Street 2:409
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2102
Mailing Address - Country:US
Mailing Address - Phone:305-924-5987
Mailing Address - Fax:
Practice Address - Street 1:9894 NW 82ND AVE
Practice Address - Street 2:409
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2102
Practice Address - Country:US
Practice Address - Phone:305-924-5987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator