Healthcare Provider Details

I. General information

NPI: 1003829227
Provider Name (Legal Business Name): NOVA ORTHOPEDIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 SW 1ST ST
MIAMI FL
33135-2203
US

IV. Provider business mailing address

1420 SW 1ST ST
MIAMI FL
33135-2203
US

V. Phone/Fax

Practice location:
  • Phone: 305-545-7777
  • Fax: 305-545-8163
Mailing address:
  • Phone: 305-545-7777
  • Fax: 305-545-8163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER J LEYVA
Title or Position: PRESIDENT
Credential:
Phone: 305-545-7777