Organization
VIDA MEDICAL REHAB CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PEDRO HERRERA (OWNER)
(786) 803-8596
Entity
Organization
Contact information
Practice address
1840 W 49TH ST STE 304, HIALEAH, FL 33012-2965
(305) 200-1012
Mailing address
1840 W 49TH ST STE 304, HIALEAH, FL 33012-2965
(305) 200-1012
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QC1500X
Community Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114105800
—
FL
01
—
115626900
THERAPIST (PT, OT, ST)
FL
Enumeration date
06/11/2019
Last updated
04/03/2024
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