Healthcare Provider Details

I. General information

NPI: 1083324883
Provider Name (Legal Business Name): VIVAGEN HEALTH CORAL RIDGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 N FEDERAL HWY K5
FORT LAUDERDALE FL
33306-1066
US

IV. Provider business mailing address

3200 N FEDERAL HWY K5
FORT LAUDERDALE FL
33306-1066
US

V. Phone/Fax

Practice location:
  • Phone: 954-440-6468
  • Fax:
Mailing address:
  • Phone: 954-440-6468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PROF. ERIK G CAMP
Title or Position: MANAGER
Credential: PA
Phone: 954-440-6468