Provider Demographics
NPI:1952167645
Name:BUENA VIDA WELLNESS CENTER II CORP
Entity Type:Organization
Organization Name:BUENA VIDA WELLNESS CENTER II CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-291-7732
Mailing Address - Street 1:6460 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3008
Mailing Address - Country:US
Mailing Address - Phone:561-291-7732
Mailing Address - Fax:561-318-3861
Practice Address - Street 1:6460 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3008
Practice Address - Country:US
Practice Address - Phone:561-291-7732
Practice Address - Fax:561-318-3861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care