Healthcare Provider Details

I. General information

NPI: 1770255549
Provider Name (Legal Business Name): VACA IN HOSPITAL ENTERPRISES. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 W FLAGLER ST STE 2J
MIAMI FL
33144-2069
US

IV. Provider business mailing address

8260 W FLAGLER ST STE 2J
MIAMI FL
33144-2069
US

V. Phone/Fax

Practice location:
  • Phone: 305-229-0551
  • Fax: 305-229-1823
Mailing address:
  • Phone: 305-229-0551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CARLOS E VACA
Title or Position: OWNER
Credential: MD
Phone: 305-229-0551