=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942121108
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZETA NOVA CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2026
-----------------------------------------------------
Last Update Date | 07/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10250 SW 56TH ST STE B203
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33165-7095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-364-5392
-----------------------------------------------------
Fax | 305-675-8414
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10250 SW 56TH ST STE B203
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33165-7095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-364-5392
-----------------------------------------------------
Fax | 305-675-8414
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESEIDENT
-----------------------------------------------------
Name | SANDRA DOMINGUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-364-5392
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------