Healthcare Provider Details

I. General information

NPI: 1447161732
Provider Name (Legal Business Name): VIDA LUXE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO CEIBA BAJA KM 117.4 EDIFICIO OCEAN PLAZA
AGUADILLA PR
00605
US

IV. Provider business mailing address

117 CALLE ZORZAL
AGUADILLA PR
00603-6758
US

V. Phone/Fax

Practice location:
  • Phone: 787-248-0629
  • Fax:
Mailing address:
  • Phone: 787-248-0629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: LESLIE GONZALEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-248-0629