Basic Information
| Provider Information | |||||||||
| NPI: | 1922581750 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NOVA SOUTHEASTEN UNIVERSITY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 S UNIVERSITY DR | ||||||||
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| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333282018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542624343 | ||||||||
| FaxNumber: | 9542622269 | ||||||||
| Practice Location | |||||||||
| Address1: | 3321 COLLEGE AVE STE 407 | ||||||||
| Address2: | |||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333147705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542624343 | ||||||||
| FaxNumber: | 9542622269 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2018 | ||||||||
| LastUpdateDate: | 09/07/2018 | ||||||||
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| AuthorizedOfficialLastName: | ESTEVEZ | ||||||||
| AuthorizedOfficialFirstName: | ROSEMERY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7862624343 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.