Provider Demographics
NPI:1851665731
Name:VIDA MEDICAL EQUIPMENT LLC
Entity Type:Organization
Organization Name:VIDA MEDICAL EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-581-1508
Mailing Address - Street 1:105 PALMVIEW DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:PALMVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:78572-8778
Mailing Address - Country:US
Mailing Address - Phone:956-581-1508
Mailing Address - Fax:
Practice Address - Street 1:105 PALMVIEW DR
Practice Address - Street 2:SUITE D
Practice Address - City:PALMVIEW
Practice Address - State:TX
Practice Address - Zip Code:78572-8778
Practice Address - Country:US
Practice Address - Phone:956-581-1508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies