Healthcare Provider Details

I. General information

NPI: 1790399053
Provider Name (Legal Business Name): VITALITY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8348 BIRD RD
MIAMI FL
33155-3354
US

IV. Provider business mailing address

8950 SW 152ND ST
PALMETTO BAY FL
33157-1901
US

V. Phone/Fax

Practice location:
  • Phone: 305-741-9565
  • Fax: 305-397-1714
Mailing address:
  • Phone: 305-741-9565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CARLOS ANTONIO SANTANA
Title or Position: PRESIDENT
Credential:
Phone: 786-461-9959