Healthcare Provider Details

I. General information

NPI: 1811614183
Provider Name (Legal Business Name): UNIVIDA MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16201 SW 95TH AVE
CUTLER BAY FL
33157-3468
US

IV. Provider business mailing address

4353 NW 77TH AVE
MIAMI FL
33166-6736
US

V. Phone/Fax

Practice location:
  • Phone: 305-204-0333
  • Fax: 305-359-7546
Mailing address:
  • Phone: 305-204-0333
  • Fax: 305-359-7546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: LUIS CASTRO
Title or Position: MANAGING PARTNER
Credential:
Phone: 305-204-0333