Provider Demographics
NPI:1477319812
Name:VIDA WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:VIDA WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOCORRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-246-7822
Mailing Address - Street 1:50 BISCAYNE BLVD APT 4607
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-2950
Mailing Address - Country:US
Mailing Address - Phone:786-246-7822
Mailing Address - Fax:855-620-6874
Practice Address - Street 1:50 BISCAYNE BLVD APT 4607
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-2950
Practice Address - Country:US
Practice Address - Phone:786-246-7822
Practice Address - Fax:855-620-6874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-23
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center