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General NPI Number Information
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NPI Number | 1073219804
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Entity Type | Organization
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Legal Business Name | NOVA DIAGNOSTIX LLC
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Dates
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Enumeration Date | 02/02/2023
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Last Update Date | 02/02/2023
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Provider Practice Location Address
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Address Line | 1601 W REYNOLDS ST STE 100
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City | PLANT CITY
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State | FL
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Zip | 33563-4748
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Country | US
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Telephone | 917-744-5433
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Fax |
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Provider Business Mailing Address
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Address Line | 4085 HEMLOCK LN
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City | TITUSVILLE
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State | FL
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Zip | 32780-2822
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Country | US
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Telephone | 917-744-5433
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN MIZRACHI
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Credential |
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Telephone | 917-744-5433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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