MEDICARE: HUMANIS VITA HEALTH CARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1720812381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUMANIS VITA HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	4445 W 16TH AVE STE 300
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7190
Country	:	US
Telephone Number	:	786-778-7449
Fax Number	:	786-685-3908

Provider Business Practice Location Address
First Line	:	4445 W 16TH AVE STE 300
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7190
Country	:	US
Telephone Number	:	786-778-7449
Fax Number	:	786-685-3908

Authorized Official
Title or Position	:	OWNER
Name	:	JUAN ACOSTA GUZMAN
Credential	:	ARNP
Telephone Number	:	786-234-7253

Provider Enumeration Date	:	08/27/2024
Last Update Date	:	08/27/2024

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