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NPI Code Detail

MEDICARE: VIDA WELLNESS MEDICAL CENTER INC

MEDICARE: VIDA WELLNESS MEDICAL CENTER INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center
2261QH0100XHealth Service Clinic/Center
3261QM0850XAdult Mental Health Clinic/Center
4261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1023726346
Entity Type Code : Organization
Provider Name (Legal Business Name) : VIDA WELLNESS MEDICAL CENTER INC
Provider Business Mailing Address
First Line : 5449 TUNIS AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89122-7230
Country : US
Telephone Number : 541-905-0544
Fax Number :
Provider Business Practice Location Address
First Line : 5449 TUNIS AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89122-7230
Country : US
Telephone Number : 541-905-0544
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : MRS. MARIA PILAR BRITO-SANCHEZ
Credential :
Telephone Number : 541-905-0544
Provider Enumeration Date : 11/07/2022
Last Update Date : 11/07/2022

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Directions to “VIDA WELLNESS MEDICAL CENTER INC ” Practice Location

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