Healthcare Provider Details

I. General information

NPI: 1053205344
Provider Name (Legal Business Name): NUEVA VIDA DIALYSIS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2344 NW 7TH ST
MIAMI FL
33125-3249
US

IV. Provider business mailing address

2344 NW 7TH ST
MIAMI FL
33125-3249
US

V. Phone/Fax

Practice location:
  • Phone: 305-786-7547
  • Fax: 786-687-5231
Mailing address:
  • Phone: 305-786-7547
  • Fax: 786-687-5231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROSY MARIAN FERNANDEZ
Title or Position: OWNER
Credential:
Phone: 305-786-7547