| La Vida Medical Group , Inc | |
|
120 State St E Ste 101 Oldsmar FL 34677-3647 | |
| (813) 296-6266 | |
| Not Available |
| Full Name | La Vida Medical Group , Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 120 State St E Ste 101, Oldsmar, Florida |
| Authorized Official Name and Position | Sanlly Perez Ceballos (PRESIDENT) |
| Authorized Official Contact | 8132966266 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| La Vida Medical Group , Inc 120 State St E Ste 101 Oldsmar FL 34677-3647 Ph: (813) 296-6266 | La Vida Medical Group , Inc 120 State St E Ste 101 Oldsmar FL 34677-3647 Ph: (813) 296-6266 |
| NPI Number | 1982377065 |
|---|---|
| Provider Enumeration Date | 07/26/2021 |
| Last Update Date | 03/10/2023 |
| Medicare PECOS PAC ID | 2769880350 |
|---|---|
| Medicare Enrollment ID | O20211012003000 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982377065 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Sanlly Perez Ceballos |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356728067 PECOS PAC ID: 2062761042 Enrollment ID: I20180824000504 |
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