Healthcare Provider Details

I. General information

NPI: 1417781527
Provider Name (Legal Business Name): NOVA MEDICAL SERVICES PAIN MANAGEMENT & ANESTHESIOLOGY DIVISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 W FLAGLER ST STE 2I
MIAMI FL
33144-2069
US

IV. Provider business mailing address

8260 W FLAGLER ST STE 2I
MIAMI FL
33144-2069
US

V. Phone/Fax

Practice location:
  • Phone: 786-715-9183
  • Fax: 786-713-1115
Mailing address:
  • Phone: 786-715-9183
  • Fax: 786-713-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IVAN DARIO CANAS JR.
Title or Position: CEO
Credential: DNP, MBA
Phone: 786-715-9183