Basic Information
| Provider Information | |||||||||
| NPI: | 1700228723 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VIDA MEDICAL ASSOCIATES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25098 OLYMPIA AVE | ||||||||
| Address2: | STE 4A | ||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339503938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9412065200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25098 OLYMPIA AVE | ||||||||
| Address2: | STE 4A | ||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339503938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9412065200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2013 | ||||||||
| LastUpdateDate: | 07/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | CABRERA | ||||||||
| AuthorizedOfficialFirstName: | JORGE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9412065200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QB0002X | ME115384 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Bariatric Medicine |
No ID Information.