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General NPI Number Information
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NPI Number | 1811532658
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Entity Type | Organization
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Legal Business Name | VIDA HEALTH CARE
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Dates
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Enumeration Date | 11/15/2019
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 881 E 2ND AVE
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City | HIALEAH
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State | FL
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Zip | 33010-4205
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Country | US
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Telephone | 305-882-1100
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Fax | 305-503-7292
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Provider Business Mailing Address
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Address Line | 881 E 2ND AVE
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City | HIALEAH
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State | FL
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Zip | 33010-4205
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Country | US
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Telephone | 305-882-1100
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Fax | 305-503-7292
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Authorized Official
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Title or Position | VP
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Name | RUBEL RODRIGUEZ
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Credential | OTHER
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Telephone | 305-570-5235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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