Healthcare Provider Details

I. General information

NPI: 1013155456
Provider Name (Legal Business Name): VIMED CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 W FLAGLER ST SUITE 2I
MIAMI FL
33144-2069
US

IV. Provider business mailing address

8260 W FLAGLER ST SUITE 2I
MIAMI FL
33144-2069
US

V. Phone/Fax

Practice location:
  • Phone: 305-559-2224
  • Fax: 305-559-2123
Mailing address:
  • Phone: 305-559-2224
  • Fax: 305-559-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME71662
License Number StateFL

VIII. Authorized Official

Name: DR. JUSTO H VILLANUEVA
Title or Position: PRESIDENT
Credential: MD
Phone: 305-559-2224