Provider Demographics
NPI:1992424832
Name:VIDA PLUS MEDICAL LLC
Entity type:Organization
Organization Name:VIDA PLUS MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-363-0406
Mailing Address - Street 1:339 CYPRESS PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3315
Mailing Address - Country:US
Mailing Address - Phone:407-910-1555
Mailing Address - Fax:407-910-1577
Practice Address - Street 1:339 CYPRESS PKWY STE 250
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3315
Practice Address - Country:US
Practice Address - Phone:407-910-1555
Practice Address - Fax:407-910-1577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty