Provider Demographics
NPI:1790514032
Name:CLINICA VIDA SANA LLC
Entity type:Organization
Organization Name:CLINICA VIDA SANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:AUGUSTINE
Authorized Official - Last Name:MONTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-725-2777
Mailing Address - Street 1:9555 WILCREST DR STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-2169
Mailing Address - Country:US
Mailing Address - Phone:281-809-3055
Mailing Address - Fax:
Practice Address - Street 1:9555 WILCREST DR STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-2169
Practice Address - Country:US
Practice Address - Phone:281-809-3055
Practice Address - Fax:281-809-3843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty