MEDICARE: VYTALYZE MINDS CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	251B00000X	Case Management Agency
3	343900000X	Non-emergency Medical Transport (VAN)
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	672191	OTHER	FL	JCAHO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	12488	OTHER	FL	AHCA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588275150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VYTALYZE MINDS CORP

Provider Business Mailing Address
First Line	:	2300 W 84TH ST STE 601
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5780
Country	:	US
Telephone Number	:	305-363-4001
Fax Number	:	305-363-4002

Provider Business Practice Location Address
First Line	:	2300 W 84TH ST STE 601
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-5780
Country	:	US
Telephone Number	:	305-363-4001
Fax Number	:	305-363-4002

Authorized Official
Title or Position	:	P
Name	:	OSVALDO LEON HERRERA
Credential	:
Telephone Number	:	305-363-4001

Provider Enumeration Date	:	08/16/2020
Last Update Date	:	02/28/2025

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Directions to “VYTALYZE MINDS CORP ” Practice Location

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