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General NPI Number Information
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NPI Number | 1447161732
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Entity Type | Organization
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Legal Business Name | VIDA LUXE GROUP LLC
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Dates
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Enumeration Date | 09/15/2026
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Last Update Date | 09/15/2026
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Provider Practice Location Address
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Address Line | BO CEIBA BAJA KM 117.4 EDIFICIO OCEAN PLAZA
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City | AGUADILLA
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State | PR
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Zip | 00605
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Country | US
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Telephone | 787-248-0629
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Fax |
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Provider Business Mailing Address
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Address Line | 117 CALLE ZORZAL
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City | AGUADILLA
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State | PR
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Zip | 00603-6758
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Country | US
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Telephone | 787-248-0629
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LESLIE GONZALEZ
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Credential |
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Telephone | 787-248-0629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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