Healthcare Provider Details

I. General information

NPI: 1942121108
Provider Name (Legal Business Name): ZETA NOVA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10250 SW 56TH ST STE B203
MIAMI FL
33165-7095
US

IV. Provider business mailing address

10250 SW 56TH ST STE B203
MIAMI FL
33165-7095
US

V. Phone/Fax

Practice location:
  • Phone: 305-364-5392
  • Fax: 305-675-8414
Mailing address:
  • Phone: 305-364-5392
  • Fax: 305-675-8414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SANDRA DOMINGUEZ
Title or Position: PRESEIDENT
Credential:
Phone: 305-364-5392