Nova Spine and Joint LLC

850 NW 42nd Avenue Suite 309

MIAMI, FL, 33186-0000
Ph # : (786)796-8009
Fax # : (305)203-0546

Thursday, February 15, 2024

Marietta Basnueva
DEA : NPI : 1932740438
Nova Spine and Joint Miami Office
850 NW 42nd Avenue Suite 309 MIAMI, FL 33186-0000
Phone: (786)796-8009 Fax : (305)203-0546
PATIENT : PEDRO LUIS BUSTAMENTE DOB : 09/19/1986 GENDER : Male
733 E 40TH ST HIALEAH, FL 33013 MR #: 431
Mobile No: (305)301-7585 Email:

Radiology Order

Test Priority ICD's Reason Do By

MRI LUMB SPINE WO

M5450 02/14/2024
CO

Signature :

Marietta Basnueva APRN- FNP, ANCC

(APRN11004339)

Printed By : Luis Chavez Printed On : 02/15/2024 12:41 PM 1/1