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NPI Code Detail

MEDICARE: VIDA GROUP SERVICES, INC.

MEDICARE: VIDA GROUP SERVICES, 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
1111NX0800XOrthopedic Chiropractor
2207Q00000XFamily Medicine Physician
3207R00000XInternal Medicine Physician
4208100000XPhysical Medicine & Rehabilitation Physician
5111NR0200XRadiology Chiropractor

General Provider Information

NPI Number : 1407097876
Entity Type Code : Organization
Provider Name (Legal Business Name) : VIDA GROUP SERVICES, INC.
Provider Business Mailing Address
First Line : 777 NW 72ND AVE
Second Line : SUITE 3157
City : MIAMI
State : FL
Zip : 33126-3009
Country : US
Telephone Number : 786-712-7312
Fax Number : 305-675-5755
Provider Business Practice Location Address
First Line : 777 NW 72ND AVE
Second Line : SUITE 3157
City : MIAMI
State : FL
Zip : 33126-3009
Country : US
Telephone Number : 786-712-7312
Fax Number : 305-675-5755
Authorized Official
Title or Position : PRESIDENT
Name : VICTOR RAMON CASTILLO
Credential :
Telephone Number : 786-768-4882
Provider Enumeration Date : 03/16/2009
Last Update Date : 09/02/2009

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Directions to “VIDA GROUP SERVICES, INC. ” Practice Location

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