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General NPI Number Information
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NPI Number | 1548189772
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Entity Type | Organization
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Legal Business Name | ETERNA VIDA MEDICAL CENTER LLC
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Dates
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Enumeration Date | 07/13/2026
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | 9020 SW 137TH AVE STE 250
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City | MIAMI
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State | FL
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Zip | 33186-1433
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Country | US
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Telephone | 786-309-0168
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Fax |
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Provider Business Mailing Address
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Address Line | 6296 CORPORATE CT STE B101
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City | FORT MYERS
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State | FL
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Zip | 33919-3535
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ORELVYS MADRUGA
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Credential |
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Telephone | 786-309-0168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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