Healthcare Provider Details

I. General information

NPI: 1346158847
Provider Name (Legal Business Name): OLIVO DE VIDA HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13255 SW 137TH AVE STE 212
MIAMI FL
33186-5328
US

IV. Provider business mailing address

8901 SW 200TH ST
CUTLER BAY FL
33157-8975
US

V. Phone/Fax

Practice location:
  • Phone: 305-202-3858
  • Fax:
Mailing address:
  • Phone: 305-202-3858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARLON BREA SANTANA
Title or Position: OWNER
Credential:
Phone: 305-202-3858