Provider Demographics
NPI:1861276156
Name:BELLA VIDA WELLNESS SERVICES INC
Entity type:Organization
Organization Name:BELLA VIDA WELLNESS SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTONOMOUS NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LEONIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:786-286-7041
Mailing Address - Street 1:4483 NW 36TH ST STE 112
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7260
Mailing Address - Country:US
Mailing Address - Phone:305-392-0106
Mailing Address - Fax:
Practice Address - Street 1:4483 NW 36TH ST STE 112
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-7260
Practice Address - Country:US
Practice Address - Phone:305-392-0106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty