Healthcare Provider Details

I. General information

NPI: 1902518988
Provider Name (Legal Business Name): NOVA MEDICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 W PEORIA AVE STE D805
PHOENIX AZ
85029-4600
US

IV. Provider business mailing address

727 E BETHANY HOME RD STE B112
PHOENIX AZ
85014-2151
US

V. Phone/Fax

Practice location:
  • Phone: 602-569-5437
  • Fax: 855-583-3686
Mailing address:
  • Phone: 602-279-2400
  • Fax: 602-603-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MIRTA CELINA DALOTTO
Title or Position: CEO
Credential:
Phone: 602-569-5437