Provider Demographics
NPI:1740925692
Name:NOVA MEDICAL & WELLNESS CENTRE INC
Entity type:Organization
Organization Name:NOVA MEDICAL & WELLNESS CENTRE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JULES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:954-998-8629
Mailing Address - Street 1:7800 NW 44TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6206
Mailing Address - Country:US
Mailing Address - Phone:954-998-8629
Mailing Address - Fax:
Practice Address - Street 1:7800 NW 44TH ST
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351-6206
Practice Address - Country:US
Practice Address - Phone:954-998-8629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJ420460654420OtherDRIVE LICENSE