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General NPI Number Information
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NPI Number | 1609135755
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Entity Type | Organization
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Legal Business Name | SAINNOVAL SURGICAL, LLC
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Dates
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Enumeration Date | 05/10/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 105 NE 19TH DR
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City | OKEECHOBEE
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State | FL
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Zip | 34972-1933
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Country | US
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Telephone | 863-623-4486
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Fax | 863-623-4487
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Provider Business Mailing Address
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Address Line | 105 NE 19TH DR
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City | OKEECHOBEE
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State | FL
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Zip | 34972-1933
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Country | US
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Telephone | 863-623-4486
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Fax | 863-623-4487
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Authorized Official
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Title or Position | MEMBER
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Name | DR. GREGORY SAINNOVAL
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Credential | M.D.
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Telephone | 863-623-4486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 112305
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME112305
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License Number State | FL
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