Healthcare Provider Details

I. General information

NPI: 1962741777
Provider Name (Legal Business Name): THE NOVA COSMETIC AND REHABILITATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9722 SW 184TH ST
CUTLER BAY FL
33157-6987
US

IV. Provider business mailing address

9722 SW 184TH ST
CUTLER BAY FL
33157-6987
US

V. Phone/Fax

Practice location:
  • Phone: 786-429-3312
  • Fax: 786-953-5442
Mailing address:
  • Phone: 786-429-3312
  • Fax: 786-953-5442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberHCC9718
License Number StateFL

VIII. Authorized Official

Name: ERICK JUAREZ
Title or Position: OWNER
Credential: MD
Phone: 786-429-3312