Healthcare Provider Details

I. General information

NPI: 1619611761
Provider Name (Legal Business Name): ONEVIDA MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 COLLINS AVE APT 1907
MIAMI BEACH FL
33140-2348
US

IV. Provider business mailing address

5757 COLLINS AVE APT 1907
MIAMI BEACH FL
33140-2348
US

V. Phone/Fax

Practice location:
  • Phone: 305-282-2109
  • Fax:
Mailing address:
  • Phone: 305-282-2109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOSE SANCHEZ
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 305-282-2109