Provider Demographics
NPI:1336898774
Name:AV LIFE AND HEALTH INSURANCE LLC DBA UNIVIDA MEDICAL CENTER
Entity Type:Organization
Organization Name:AV LIFE AND HEALTH INSURANCE LLC DBA UNIVIDA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MESA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-510-6778
Mailing Address - Street 1:7000 W 12TH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5154
Mailing Address - Country:US
Mailing Address - Phone:305-510-6778
Mailing Address - Fax:
Practice Address - Street 1:7000 W 12TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-5154
Practice Address - Country:US
Practice Address - Phone:305-510-6778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty