# NEW WAVE MEDICAL GROUP PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912655069
- **Authorized official:** DALIA ELIZALDE (MANAGER)
- **Authorized official phone:** (844) 327-2199

## Contact information

- **Practice address:** 9018 60TH AVE E, BRADENTON, FL 34202-9642
- **Practice address phone:** (844) 327-2199
- **Mailing address:** 9018 60TH AVE E, BRADENTON, FL 34202-9642
- **Mailing address phone:** (844) 327-2199

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/16/2022
- **Last updated:** 01/27/2023