Provider Demographics
NPI:1386709780
Name:ZEN VIDA MEDICAL SPA, LLC
Entity type:Organization
Organization Name:ZEN VIDA MEDICAL SPA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:DEL C
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-594-7632
Mailing Address - Street 1:10773 NW 58TH ST
Mailing Address - Street 2:STE 213
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2801
Mailing Address - Country:US
Mailing Address - Phone:305-594-7632
Mailing Address - Fax:954-255-9631
Practice Address - Street 1:10773 NW 58TH ST
Practice Address - Street 2:STE 213
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2801
Practice Address - Country:US
Practice Address - Phone:305-594-7632
Practice Address - Fax:954-255-9631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42709207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty