Healthcare Provider Details

I. General information

NPI: 1013355999
Provider Name (Legal Business Name): ITALO CARLOS NOVOA REYES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 SE OCEAN BLVD
STUART FL
34996-2576
US

IV. Provider business mailing address

789 W YAMATO RD APT 413
BOCA RATON FL
33431-4531
US

V. Phone/Fax

Practice location:
  • Phone: 772-781-0222
  • Fax:
Mailing address:
  • Phone: 305-343-6992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME150853
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME150853
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: