MEDICARE: VIDAVITALE CONCIERGE NURSING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse

General Provider Information

NPI Number	:	1093646457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIDAVITALE CONCIERGE NURSING LLC

Provider Business Mailing Address
First Line	:	4040 BROADWAY STE 525
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-6300
Country	:	US
Telephone Number	:	210-880-5159
Fax Number	:

Provider Business Practice Location Address
First Line	:	4040 BROADWAY STE 525
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-6300
Country	:	US
Telephone Number	:	210-880-5159
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	CHRISTINA MARIE GARCIA
Credential	:	RN
Telephone Number	:	210-880-5159

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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