Provider Demographics
NPI:1861108342
Name:SOMOS VIDA MEDICAL MULTISERVICE LLC
Entity type:Organization
Organization Name:SOMOS VIDA MEDICAL MULTISERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ APRN
Authorized Official - Prefix:
Authorized Official - First Name:YUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-239-8860
Mailing Address - Street 1:4064 SW 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-6688
Mailing Address - Country:US
Mailing Address - Phone:954-239-8860
Mailing Address - Fax:954-239-8847
Practice Address - Street 1:4064 SW 69TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-6688
Practice Address - Country:US
Practice Address - Phone:954-239-8860
Practice Address - Fax:954-239-8847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty