Healthcare Provider Details

I. General information

NPI: 1841163235
Provider Name (Legal Business Name): JUSELIZ CORAL LEFEBRE VIDAL MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7280 STIRLING RD APT 105
HOLLYWOOD FL
33024-1676
US

IV. Provider business mailing address

7280 STIRLING RD APT 105
HOLLYWOOD FL
33024-1676
US

V. Phone/Fax

Practice location:
  • Phone: 954-609-5464
  • Fax:
Mailing address:
  • Phone: 954-609-5464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: