Healthcare Provider Details

I. General information

NPI: 1659281590
Provider Name (Legal Business Name): VIDA FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 S 11TH AVE STE 48
YAKIMA WA
98902-3205
US

IV. Provider business mailing address

206 S 11TH AVE STE 48
YAKIMA WA
98902-3205
US

V. Phone/Fax

Practice location:
  • Phone: 801-419-7934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAIME RICARDO PEREZ
Title or Position: NP
Credential: ARNP
Phone: 801-419-7934