Provider Demographics
NPI:1669645131
Name:LA VIDA MEDICAL GROUP PSC
Entity Type:Organization
Organization Name:LA VIDA MEDICAL GROUP PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-880-2363
Mailing Address - Street 1:549 CALLE DEL MAR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-2869
Mailing Address - Country:US
Mailing Address - Phone:787-880-2363
Mailing Address - Fax:
Practice Address - Street 1:549 CALLE DEL MAR
Practice Address - Street 2:SUITE 303
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-2869
Practice Address - Country:US
Practice Address - Phone:787-880-2363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12097207Q00000X
PR9835207R00000X
PR57042085R0202X
PR13836208D00000X
PR16341208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty