Provider Demographics
NPI:1609177310
Name:VIDA HEALTH CENTERS, INC.
Entity Type:Organization
Organization Name:VIDA HEALTH CENTERS, INC.
Other - Org Name:DOCTORS HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLADARES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:305-882-1100
Mailing Address - Street 1:881 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4205
Mailing Address - Country:US
Mailing Address - Phone:305-882-1100
Mailing Address - Fax:305-887-3273
Practice Address - Street 1:881 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4205
Practice Address - Country:US
Practice Address - Phone:305-882-1100
Practice Address - Fax:305-887-3273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center