Provider Demographics
NPI:1356558787
Name:VIDA SANA MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:VIDA SANA MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1559-562-9399
Mailing Address - Street 1:23222781 SEQUOIA AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LINDSAY
Mailing Address - State:CA
Mailing Address - Zip Code:93247-1422
Mailing Address - Country:US
Mailing Address - Phone:155-956-2939
Mailing Address - Fax:155-956-2937
Practice Address - Street 1:781 N. SEQUOIA AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LINDSAY
Practice Address - State:CA
Practice Address - Zip Code:93247-1422
Practice Address - Country:US
Practice Address - Phone:155-956-2939
Practice Address - Fax:155-956-2937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care