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General NPI Number Information
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NPI Number | 1013355999
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Entity Type | Individual
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Provider Name | ITALO CARLOS NOVOA REYES MD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2013
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Last Update Date | 07/13/2021
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Provider Practice Location Address
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Address Line | 1027 SE OCEAN BLVD
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City | STUART
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State | FL
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Zip | 34996-2576
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Country | US
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Telephone | 772-781-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 789 W YAMATO RD APT 413
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City | BOCA RATON
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State | FL
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Zip | 33431-4531
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Country | US
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Telephone | 305-343-6992
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME150853
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | ME150853
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License Number State | FL
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