Healthcare Provider Details

I. General information

NPI: 1316838030
Provider Name (Legal Business Name): DODAVAH HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 SE 7TH ST
CAPE CORAL FL
33990-1545
US

IV. Provider business mailing address

106 SE 7TH ST
CAPE CORAL FL
33990-1545
US

V. Phone/Fax

Practice location:
  • Phone: 305-509-1202
  • Fax:
Mailing address:
  • Phone: 305-509-1202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEREN PUPO LOSADA
Title or Position: RN
Credential:
Phone: 305-509-1202