Healthcare Provider Details

I. General information

NPI: 1053101485
Provider Name (Legal Business Name): NOVA MEDICAL FL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12277 SW 130TH ST
MIAMI FL
33186-6218
US

IV. Provider business mailing address

12277 SW 130TH ST
MIAMI FL
33186-6218
US

V. Phone/Fax

Practice location:
  • Phone: 305-244-5883
  • Fax: 305-203-0546
Mailing address:
  • Phone: 305-244-5883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDRES ZAPATA
Title or Position: ADMIN
Credential:
Phone: 305-244-5883