MEDICARE: JUSELIZ CORAL LEFEBRE VIDAL MT-BC

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
1	171W00000X	Contractor		FL
2	225A00000X	Music Therapist		FL

General Provider Information

NPI Number	:	1841163235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSELIZ CORAL LEFEBRE VIDAL MT-BC

Provider Business Mailing Address
First Line	:	7280 STIRLING RD APT 105
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-1676
Country	:	US
Telephone Number	:	954-609-5464
Fax Number	:

Provider Business Practice Location Address
First Line	:	7280 STIRLING RD APT 105
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-1676
Country	:	US
Telephone Number	:	954-609-5464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2025
Last Update Date	:	10/15/2025

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Directions to “ JUSELIZ CORAL LEFEBRE VIDAL MT-BC” Practice Location

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