Provider Demographics
NPI:1275202392
Name:BUENA VIDA WELLNESS CENTER, CORP
Entity Type:Organization
Organization Name:BUENA VIDA WELLNESS CENTER, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-335-3638
Mailing Address - Street 1:12769 SW 42ND ST STE 28-32
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3429
Mailing Address - Country:US
Mailing Address - Phone:305-576-9999
Mailing Address - Fax:305-722-3586
Practice Address - Street 1:12769 SW 42ND ST STE 28-32
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3429
Practice Address - Country:US
Practice Address - Phone:305-576-9999
Practice Address - Fax:305-722-3586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care