Provider Demographics
NPI:1093301335
Name:VIVIFY D & P COMMUNITY MENTAL HEALTH CARE INC
Entity Type:Organization
Organization Name:VIVIFY D & P COMMUNITY MENTAL HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ODALYS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-333-9460
Mailing Address - Street 1:7420 SW 48TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4415
Mailing Address - Country:US
Mailing Address - Phone:786-755-2615
Mailing Address - Fax:
Practice Address - Street 1:7420 SW 48TH ST STE A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4415
Practice Address - Country:US
Practice Address - Phone:786-755-2615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)