Provider Demographics
NPI:1194139824
Name:VIDA INTEGRA DESAROLLANDO ARMONIA (VIDA), LLC
Entity type:Organization
Organization Name:VIDA INTEGRA DESAROLLANDO ARMONIA (VIDA), LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHIA
Authorized Official - Middle Name:JAZMIN
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:MA PSY
Authorized Official - Phone:787-528-6446
Mailing Address - Street 1:#46 CALLE 15
Mailing Address - Street 2:PARCELAS HILL BROTHER
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-528-6446
Mailing Address - Fax:
Practice Address - Street 1:URB. MUNOZ RIVERA CALLE ACUARELA 3
Practice Address - Street 2:KOI BLDG. G-10
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-528-6446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty