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General NPI Number Information
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NPI Number | 1447883103
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Entity Type | Organization
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Legal Business Name | VIDAMER HEALTH INC
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Dates
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Enumeration Date | 02/20/2020
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | 10300 SUNSET DR STE 232
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City | MIAMI
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State | FL
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Zip | 33173-3003
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Country | US
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Telephone | 305-982-8913
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Fax | 786-991-2304
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Provider Business Mailing Address
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Address Line | 10300 SUNSET DR STE 232
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City | MIAMI
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State | FL
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Zip | 33173-3003
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Country | US
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Telephone | 305-982-8913
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Fax | 786-991-2304
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Authorized Official
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Title or Position | PRESIDENT
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Name | IVAN RAFAEL VALDES ABREU
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Credential | APRN-FNP-C
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Telephone | 305-982-8913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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