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General NPI Number Information
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NPI Number | 1336851880
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Entity Type | Organization
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Legal Business Name | UNIVIDA MEDICAL CENTER LLC
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Dates
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Enumeration Date | 12/15/2022
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 15225 NW 77TH AVE
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City | MIAMI LAKES
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State | FL
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Zip | 33014-7804
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Country | US
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Telephone | 305-587-2747
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Fax | 305-587-2748
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Provider Business Mailing Address
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Address Line | 4353 NW 77TH AVE FL 3
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City | MIAMI
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State | FL
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Zip | 33166-6736
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Country | US
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Telephone | 305-204-0333
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Fax | 305-359-7546
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | LUIS CASTRO
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Credential |
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Telephone | 305-204-0333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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