Healthcare Provider Details

I. General information

NPI: 1225947294
Provider Name (Legal Business Name): MEDNOVA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CALLE PALMER
CIALES PR
00638-3233
US

IV. Provider business mailing address

PO BOX 11
CIALES PR
00638-0011
US

V. Phone/Fax

Practice location:
  • Phone: 787-379-7515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAVIER PADILLA RIVERA
Title or Position: OWNER/PRESIDENT
Credential: PHARMD
Phone: 787-379-7515