Provider Demographics
NPI:1457342743
Name:NOVA, MIGUEL A (MD FAAFP)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:A
Last Name:NOVA
Suffix:
Gender:M
Credentials:MD FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00951-0528
Mailing Address - Country:US
Mailing Address - Phone:787-869-2599
Mailing Address - Fax:
Practice Address - Street 1:GEONGETTO 30 LA MARINA
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719
Practice Address - Country:US
Practice Address - Phone:787-869-2599
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR09602OtherIST MEDICAL
PR000-938OtherBCBS
PR02-5597OtherTRIPLE S
PR02-5097Medicare ID - Type Unspecified
D48316Medicare UPIN