Healthcare Provider Details

I. General information

NPI: 1659134336
Provider Name (Legal Business Name): VITALY MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7811 SW 24TH ST STE 120
MIAMI FL
33155-6540
US

IV. Provider business mailing address

7811 SW 24TH ST STE 120
MIAMI FL
33155-6540
US

V. Phone/Fax

Practice location:
  • Phone: 786-916-4310
  • Fax: 786-916-4311
Mailing address:
  • Phone: 305-916-4310
  • Fax: 305-916-4311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TANIA ROBAINA
Title or Position: OWNER
Credential:
Phone: 786-694-0650