Provider Demographics
NPI:1396979639
Name:BASORA ROVIRA, ELISA (MD)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:BASORA ROVIRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 MEDICAL DISTRICT DR APT 4069
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-8286
Mailing Address - Country:US
Mailing Address - Phone:787-457-0657
Mailing Address - Fax:
Practice Address - Street 1:2350 N. STEMMONS FWY (I-35)
Practice Address - Street 2:DALLAS AMBULATORY CARE PAVILLION
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207
Practice Address - Country:US
Practice Address - Phone:214-456-4630
Practice Address - Fax:214-456-5406
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1703208000000X, 2080S0012X, 2080P0214X
PR017516208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice