Healthcare Provider Details

I. General information

NPI: 1578702411
Provider Name (Legal Business Name): VITAL IMAGE HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 GLADES RD 2ND FLOOR
BOCA RATON FL
33431-6421
US

IV. Provider business mailing address

900 GLADES RD 2ND FLOOR
BOCA RATON FL
33431-6421
US

V. Phone/Fax

Practice location:
  • Phone: 561-392-0034
  • Fax: 800-928-7109
Mailing address:
  • Phone: 561-392-0034
  • Fax: 800-928-7109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberME42709
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberME42709
License Number StateFL

VIII. Authorized Official

Name: DR. ANGEL M. GARCIA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 561-392-0034