Healthcare Provider Details

I. General information

NPI: 1306822440
Provider Name (Legal Business Name): NOVALES MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 NW 22ND AVE
MIAMI FL
33125-3352
US

IV. Provider business mailing address

470 NW 22ND AVE
MIAMI FL
33125-3352
US

V. Phone/Fax

Practice location:
  • Phone: 305-643-4684
  • Fax: 305-643-4680
Mailing address:
  • Phone: 305-643-4684
  • Fax: 305-643-4680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 70533
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME 59048
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME 55079
License Number StateFL

VIII. Authorized Official

Name: MS. OLGA RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-643-4684