Provider Demographics
NPI:1194563379
Name:NOVAVITA MED CENTER LLC
Entity type:Organization
Organization Name:NOVAVITA MED CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:URSULA
Authorized Official - Last Name:HERNANDEZ MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:305-562-0802
Mailing Address - Street 1:13501 SW 136TH ST STE 208
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-8321
Mailing Address - Country:US
Mailing Address - Phone:305-284-7574
Mailing Address - Fax:
Practice Address - Street 1:13501 SW 136TH ST STE 208
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-8321
Practice Address - Country:US
Practice Address - Phone:305-284-7574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty