Provider Demographics
NPI:1205677598
Name:AQUANOVA TELEHELATH INTELLIGENCE
Entity type:Organization
Organization Name:AQUANOVA TELEHELATH INTELLIGENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:FRANCOIS
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-209-6550
Mailing Address - Street 1:18004 NW 6TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2823
Mailing Address - Country:US
Mailing Address - Phone:800-536-4270
Mailing Address - Fax:
Practice Address - Street 1:18004 NW 6TH ST STE 104
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2823
Practice Address - Country:US
Practice Address - Phone:800-536-4270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty