Provider Demographics
NPI:1780418632
Name:BUENA VIDA HEALTHCARE
Entity type:Organization
Organization Name:BUENA VIDA HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:214-305-6668
Mailing Address - Street 1:814 SMITH LN
Mailing Address - Street 2:
Mailing Address - City:SEAGOVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75159-1831
Mailing Address - Country:US
Mailing Address - Phone:469-835-3011
Mailing Address - Fax:
Practice Address - Street 1:9550 SKILLMAN ST STE 501
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-8261
Practice Address - Country:US
Practice Address - Phone:214-305-6668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-31
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty