Provider Demographics
NPI:1487925368
Name:VIDA THERAPY CENTERS
Entity type:Organization
Organization Name:VIDA THERAPY CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLADARES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:305-882-1100
Mailing Address - Street 1:881 E 2ND AVE
Mailing Address - Street 2:881 EAST 2ND AVENUE
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4205
Mailing Address - Country:US
Mailing Address - Phone:305-882-1100
Mailing Address - Fax:
Practice Address - Street 1:881 E 2ND AVE
Practice Address - Street 2:881 EAST 2ND AVENUE
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4205
Practice Address - Country:US
Practice Address - Phone:305-882-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty