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General NPI Number Information
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NPI Number | 1760125769
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Entity Type | Organization
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Legal Business Name | VIDA HEALTHCARE NETWORKS CORP
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Dates
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Enumeration Date | 04/18/2022
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 11285 SW 211TH ST STE 305
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City | CUTLER BAY
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State | FL
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Zip | 33189-2213
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Country | US
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Telephone | 305-218-9996
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Fax |
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Provider Business Mailing Address
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Address Line | 11285 SW 211TH ST STE 305
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City | CUTLER BAY
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State | FL
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Zip | 33189-2213
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Country | US
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Telephone | 305-305-2189
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERTO RODRIGUEZ
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Credential |
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Telephone | 305-218-9996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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