Provider Demographics
NPI:1720529860
Name:ROCAFORT SILVA, OMAR A (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:A
Last Name:ROCAFORT SILVA
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 1:10-4 CALLE TULIP PARQUE MONTEVERDE I
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-645-6546
Mailing Address - Fax:
Practice Address - Street 1:10-4 CALLE TULIP
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5942
Practice Address - Country:US
Practice Address - Phone:787-645-6546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21457208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice