Provider Demographics
NPI:1619557394
Name:LARGA VIDA COMMUNITY WELLNESS CENTER INC
Entity Type:Organization
Organization Name:LARGA VIDA COMMUNITY WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLEYDEN
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-253-9971
Mailing Address - Street 1:330 SW 27TH AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2957
Mailing Address - Country:US
Mailing Address - Phone:786-253-9971
Mailing Address - Fax:
Practice Address - Street 1:330 SW 27TH AVE STE 307
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2957
Practice Address - Country:US
Practice Address - Phone:786-253-9971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health