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Organization
LA VIDA MEDICAL GROUP , INC
Active
Organization
LA VIDA MEDICAL GROUP , INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANLLY PEREZ CEBALLOS MD (PRESIDENT)
(813) 296-6266
Entity
Organization
Contact information
Practice address
120 STATE ST E STE 101, OLDSMAR, FL 34677-3647
(813) 296-6266
Mailing address
120 STATE ST E STE 101, OLDSMAR, FL 34677-3647
(813) 296-6266
(813) 522-8929
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
07/26/2021
Last updated
03/10/2023
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