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General NPI Number Information
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NPI Number | 1568121192
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Entity Type | Organization
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Legal Business Name | VIDA MEDICAL CARE LLC
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Dates
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Enumeration Date | 12/10/2021
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Last Update Date | 12/10/2021
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Provider Practice Location Address
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Address Line | 2550 NW 100TH AVE FL 2
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City | DORAL
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State | FL
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Zip | 33172-1319
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Country | US
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Telephone | 305-269-7887
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Fax | 786-623-3916
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Provider Business Mailing Address
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Address Line | 2550 NW 100TH AVE FL 2
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City | DORAL
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State | FL
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Zip | 33172-1319
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Country | US
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Telephone | 305-269-7887
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | SANDY LOPEZ
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Credential |
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Telephone | 305-269-7887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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