Provider Demographics
NPI:1922479468
Name:VIDA MEDICAL CENTERS OF SWEETWATER CORP.
Entity Type:Organization
Organization Name:VIDA MEDICAL CENTERS OF SWEETWATER CORP.
Other - Org Name:VIDA MEDICAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-623-3915
Mailing Address - Street 1:10920 W FLAGLER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1243
Mailing Address - Country:US
Mailing Address - Phone:786-623-3915
Mailing Address - Fax:786-623-3916
Practice Address - Street 1:10920 W FLAGLER ST STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1243
Practice Address - Country:US
Practice Address - Phone:786-623-3915
Practice Address - Fax:786-623-3916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service