Healthcare Provider Details

I. General information

NPI: 1487925368
Provider Name (Legal Business Name): VIDA THERAPY CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 E 2ND AVE 881 EAST 2ND AVENUE
HIALEAH FL
33010-4205
US

IV. Provider business mailing address

881 E 2ND AVE 881 EAST 2ND AVENUE
HIALEAH FL
33010-4205
US

V. Phone/Fax

Practice location:
  • Phone: 305-882-1100
  • Fax:
Mailing address:
  • Phone: 305-882-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM VALLADARES JR.
Title or Position: PRESIDENT
Credential:
Phone: 305-882-1100