Healthcare Provider Details

I. General information

NPI: 1699548578
Provider Name (Legal Business Name): VULNERATI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MANATEE AVE E STE 103
BRADENTON FL
34208-1620
US

IV. Provider business mailing address

2001 MANATEE AVE E STE 103
BRADENTON FL
34208-1620
US

V. Phone/Fax

Practice location:
  • Phone: 941-803-8395
  • Fax: 941-746-8037
Mailing address:
  • Phone: 941-803-8395
  • Fax: 941-746-8037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT YCAZA
Title or Position: OWNER CEO
Credential: MD
Phone: 941-803-8395