Healthcare Provider Details

I. General information

NPI: 1194563379
Provider Name (Legal Business Name): NOVAVITA MED CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13501 SW 136TH ST STE 208
MIAMI FL
33186-8321
US

IV. Provider business mailing address

13501 SW 136TH ST STE 208
MIAMI FL
33186-8321
US

V. Phone/Fax

Practice location:
  • Phone: 305-284-7574
  • Fax:
Mailing address:
  • Phone: 305-284-7574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARIA URSULA HERNANDEZ MORAN
Title or Position: PRESIDENT
Credential: NP
Phone: 305-562-0802