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General NPI Number Information
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NPI Number | 1801291174
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Entity Type | Organization
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Legal Business Name | VIDA MEDICAL RESEARCH INC
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Dates
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Enumeration Date | 10/29/2014
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Last Update Date | 10/29/2014
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Provider Practice Location Address
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Address Line | 4910 E 2ND AVE
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City | HIALEAH
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State | FL
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Zip | 33013-1410
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Country | US
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Telephone | 786-431-1643
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Fax |
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Provider Business Mailing Address
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Address Line | 4910 E 2ND AVE
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City | HIALEAH
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State | FL
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Zip | 33013-1410
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Country | US
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Telephone | 786-431-1643
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. ANA R TAPIA
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Credential |
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Telephone | 786-431-1643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1100X
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Taxonomy Name | Research Clinic/Center
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License Number |
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License Number State |
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