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NPI Code Detail

MEDICARE: BUENA VIDA HEALTHCARE

MEDICARE: BUENA VIDA HEALTHCARE
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
1363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1780418632
Entity Type Code : Organization
Provider Name (Legal Business Name) : BUENA VIDA HEALTHCARE
Provider Business Mailing Address
First Line : 814 SMITH LN
Second Line :
City : SEAGOVILLE
State : TX
Zip : 75159-1831
Country : US
Telephone Number : 469-835-3011
Fax Number :
Provider Business Practice Location Address
First Line : 9550 SKILLMAN ST STE 501
Second Line :
City : DALLAS
State : TX
Zip : 75243-8261
Country : US
Telephone Number : 214-305-6668
Fax Number :
Authorized Official
Title or Position : FAMILY NURSE PRACTITIONER
Name : ANGELICA SOTO
Credential : FNP
Telephone Number : 214-305-6668
Provider Enumeration Date : 08/31/2024
Last Update Date : 08/31/2024

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Directions to “BUENA VIDA HEALTHCARE ” Practice Location

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