Provider Demographics
NPI:1871019729
Name:VIVA WELLNESS & INJURY, LLC
Entity Type:Organization
Organization Name:VIVA WELLNESS & INJURY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-493-3979
Mailing Address - Street 1:5703 RED BUG LAKE RD # 310
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4969
Mailing Address - Country:US
Mailing Address - Phone:407-350-5075
Mailing Address - Fax:407-350-5089
Practice Address - Street 1:7780 LAKE UNDERHILL RD STE 109
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8218
Practice Address - Country:US
Practice Address - Phone:407-350-5075
Practice Address - Fax:407-350-5089
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIVA WELLNESS & INJURY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-22
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty