Provider Demographics
NPI:1124815196
Name:NOVA GASTRO GROUP LLC
Entity type:Organization
Organization Name:NOVA GASTRO GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:DARIO
Authorized Official - Last Name:CANAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DNP, MBA
Authorized Official - Phone:786-715-9183
Mailing Address - Street 1:11420 N KENDALL DR STE 207
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1039
Mailing Address - Country:US
Mailing Address - Phone:786-715-9183
Mailing Address - Fax:786-713-1115
Practice Address - Street 1:8260 W FLAGLER ST STE 1A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2069
Practice Address - Country:US
Practice Address - Phone:786-715-9183
Practice Address - Fax:786-715-9183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty