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Organization
LA VIDA MEDICAL GROUP , INC
Active
Organization
LA VIDA MEDICAL GROUP , INC
Active
Parent organization
LA VIDA MEDICAL GROUP INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
LA VIDA MEDICAL GROUP INC
Authorized official
SANLLY PEREZ CEBALLOS MD (PRESIDENT)
(813) 296-6266
Entity
Organization
Contact information
Practice address
3802 GUNN HWY, TAMPA, FL 33618-8793
(813) 296-6266
(813) 522-8929
Mailing address
3802 GUNN HWY, TAMPA, FL 33618-8793
(813) 296-6266
(813) 522-8929
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
01/14/2025
Last updated
01/14/2025
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