MEDICARE: NOVA GENESIS HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1558242925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA GENESIS HEALTH

Provider Business Mailing Address
First Line	:	2636 W 72ND ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-5419
Country	:	US
Telephone Number	:	786-560-6826
Fax Number	:

Provider Business Practice Location Address
First Line	:	2636 W 72ND ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-5419
Country	:	US
Telephone Number	:	786-560-6826
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMAURY RODRIGUEZ VALDES
Credential	:
Telephone Number	:	786-560-6826

Provider Enumeration Date	:	09/10/2025
Last Update Date	:	09/10/2025

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Directions to “NOVA GENESIS HEALTH ” Practice Location

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