Healthcare Provider Details

I. General information

NPI: 1457314064
Provider Name (Legal Business Name): VITAL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 WEST FLASLER STREET SUITE #175
MIAMI FL
33144-2098
US

IV. Provider business mailing address

8300 W FLAGLER ST SUITE #175
MIAMI FL
33144-6000
US

V. Phone/Fax

Practice location:
  • Phone: 305-220-0300
  • Fax: 305-220-1472
Mailing address:
  • Phone: 305-220-0300
  • Fax: 305-220-1472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0045837
License Number StateFL

VIII. Authorized Official

Name: FERNANDO JOSE LORA
Title or Position: MD
Credential: MD
Phone: 305-220-0300