Provider Demographics
NPI:1396619623
Name:VIDA CARE SPINE AND INJURY CENTER
Entity type:Organization
Organization Name:VIDA CARE SPINE AND INJURY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:CERVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:786-443-1369
Mailing Address - Street 1:11160 SW 88TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-0949
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11160 SW 88TH ST STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-0949
Practice Address - Country:US
Practice Address - Phone:305-209-2777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty