MEDICARE: UNIVIDA MEDICAL CENTER 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1225880537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVIDA MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	4353 NW 77TH AVE FL 3
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33166-6736
Country	:	US
Telephone Number	:	305-204-0333
Fax Number	:	305-359-7546

Provider Business Practice Location Address
First Line	:	17100 NE 19TH AVE
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-3102
Country	:	US
Telephone Number	:	305-204-0333
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	LUIS CASTRO
Credential	:
Telephone Number	:	305-204-0333

Provider Enumeration Date	:	04/02/2024
Last Update Date	:	12/04/2025

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