Healthcare Provider Details

I. General information

NPI: 1104583640
Provider Name (Legal Business Name): NOVA MEDICAL MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 05/07/2022
Certification Date: 05/07/2022
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:
Mailing address:
  • Phone: 786-715-9183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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