Healthcare Provider Details

I. General information

NPI: 1669645131
Provider Name (Legal Business Name): LA VIDA MEDICAL GROUP PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 CALLE DEL MAR SUITE 303
HATILLO PR
00659-2869
US

IV. Provider business mailing address

549 CALLE DEL MAR SUITE 303
HATILLO PR
00659-2869
US

V. Phone/Fax

Practice location:
  • Phone: 787-880-2363
  • Fax:
Mailing address:
  • Phone: 787-880-2363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12097
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9835
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13836
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16341
License Number StatePR
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5704
License Number StatePR

VIII. Authorized Official

Name: DR. MYRIAM SAEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-880-2363