Healthcare Provider Details

I. General information

NPI: 1477731149
Provider Name (Legal Business Name): C U NAWADA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 06/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 1ST ST S
WINTER HAVEN FL
33880-3902
US

IV. Provider business mailing address

1121 1ST ST S
WINTER HAVEN FL
33880-3902
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-2924
  • Fax: 863-294-3450
Mailing address:
  • Phone: 863-293-2924
  • Fax: 863-294-3450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: C. U. NAWADA
Title or Position: OWNER
Credential: M.D,
Phone: 863-293-2924