Healthcare Provider Details

I. General information

NPI: 1235915554
Provider Name (Legal Business Name): VITA BELLA MEDICAL GROUP PA OF FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 N TATUM BLVD
PHOENIX AZ
85028-6036
US

IV. Provider business mailing address

11201 N TATUM BLVD
PHOENIX AZ
85028-6036
US

V. Phone/Fax

Practice location:
  • Phone: 602-669-7321
  • Fax:
Mailing address:
  • Phone: 602-669-7321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY HILL
Title or Position: COO
Credential:
Phone: 971-203-6246