Healthcare Provider Details

I. General information

NPI: 1780516377
Provider Name (Legal Business Name): CLINIC NOVA VIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 NW 26TH TER
CAPE CORAL FL
33993-8714
US

IV. Provider business mailing address

629 NW 26TH TER
CAPE CORAL FL
33993-8714
US

V. Phone/Fax

Practice location:
  • Phone: 315-992-0541
  • Fax: 800-990-1036
Mailing address:
  • Phone: 315-992-0541
  • Fax: 800-990-1036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: YOSVEL SOSA LOPEZ
Title or Position: PROVIDER
Credential: APRN
Phone: 315-992-0541