Provider Demographics
NPI:1316181373
Name:ROURA, NELSON
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:ROURA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 AVE DE HOSTOS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3015
Mailing Address - Country:US
Mailing Address - Phone:787-756-6195
Mailing Address - Fax:787-767-2653
Practice Address - Street 1:464 AVE DE HOSTOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3015
Practice Address - Country:US
Practice Address - Phone:787-756-6195
Practice Address - Fax:787-767-2653
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7421223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics