Provider Demographics
NPI:1164317459
Name:JU VIDAL MED LLC
Entity type:Organization
Organization Name:JU VIDAL MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:VIDAL GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-701-9081
Mailing Address - Street 1:14834 SW 35TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4857
Mailing Address - Country:US
Mailing Address - Phone:786-701-9081
Mailing Address - Fax:
Practice Address - Street 1:14834 SW 35TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4857
Practice Address - Country:US
Practice Address - Phone:786-701-9081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies