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General NPI Number Information
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NPI Number | 1275202392
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Entity Type | Organization
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Legal Business Name | BUENA VIDA WELLNESS CENTER, CORP
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Dates
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Enumeration Date | 09/11/2021
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 12769 SW 42ND ST STE 28-32
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City | MIAMI
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State | FL
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Zip | 33175-3429
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Country | US
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Telephone | 305-576-9999
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Fax | 305-722-3586
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Provider Business Mailing Address
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Address Line | 12769 SW 42ND ST STE 28-32
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City | MIAMI
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State | FL
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Zip | 33175-3429
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Country | US
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Telephone | 305-576-9999
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Fax | 305-722-3586
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARCOS DIAZ
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Credential | RN
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Telephone | 305-335-3638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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