Provider Demographics
NPI:1700228723
Name:VIDA MEDICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:VIDA MEDICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-206-5200
Mailing Address - Street 1:25098 OLYMPIA AVE
Mailing Address - Street 2:STE 4A
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3938
Mailing Address - Country:US
Mailing Address - Phone:941-206-5200
Mailing Address - Fax:
Practice Address - Street 1:25098 OLYMPIA AVE
Practice Address - Street 2:STE 4A
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3938
Practice Address - Country:US
Practice Address - Phone:941-206-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115384207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Single Specialty