Healthcare Provider Details

I. General information

NPI: 1063336972
Provider Name (Legal Business Name): NOVAVIDA HEALTH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 CALLE BARBOSA ESQ MANUEL F. ROSSY
BAYAMON PR
00960
US

IV. Provider business mailing address

HC 11 BOX 48140
CAGUAS PR
00725-9071
US

V. Phone/Fax

Practice location:
  • Phone: 787-995-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: LOURMARTIGH ORTIZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-373-1947