Provider Demographics
NPI:1063481810
Name:ROURA RIZZO, FERNANDO EUGENIO (MD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:EUGENIO
Last Name:ROURA RIZZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FERNANDO
Other - Middle Name:
Other - Last Name:ROURA RIZZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:405 ESMERALDA AVE.
Mailing Address - Street 2:SUITE 102 PMB 365
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4466
Mailing Address - Country:US
Mailing Address - Phone:787-596-1110
Mailing Address - Fax:787-790-6339
Practice Address - Street 1:405 ESMERALDA AVE.
Practice Address - Street 2:SUITE 102 PMB 365
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4466
Practice Address - Country:US
Practice Address - Phone:787-596-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14929208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
I-25549Medicare UPIN