=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528958352
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LA VIE MEDICAL CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2025
-----------------------------------------------------
Last Update Date | 07/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18590 NW 67TH AVE STE 200-200A
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33015-3460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-914-2883
-----------------------------------------------------
Fax | 305-914-6269
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18112 NW 91ST CT
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33018-6544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-914-2883
-----------------------------------------------------
Fax | 305-914-6269
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | IDANIA TERESA GARCIA DEL SOL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 786-510-9157
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR1100X
-----------------------------------------------------
Taxonomy Name | Research Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------