Provider Demographics
NPI:1114465341
Name:FAVA CAPITAL GROUP
Entity Type:Organization
Organization Name:FAVA CAPITAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:FAVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-798-4065
Mailing Address - Street 1:7701 N KENDALL DR
Mailing Address - Street 2:B328
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7594
Mailing Address - Country:US
Mailing Address - Phone:305-798-4065
Mailing Address - Fax:
Practice Address - Street 1:7701 N KENDALL DR
Practice Address - Street 2:B328
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7594
Practice Address - Country:US
Practice Address - Phone:305-798-4065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health