Healthcare Provider Details

I. General information

NPI: 1720661663
Provider Name (Legal Business Name): VITA MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13028 SW 120TH ST FL 1
MIAMI FL
33186-4522
US

IV. Provider business mailing address

13028 SW 120TH ST FL 1
MIAMI FL
33186-4522
US

V. Phone/Fax

Practice location:
  • Phone: 786-592-2785
  • Fax: 786-592-1476
Mailing address:
  • Phone: 786-592-2785
  • Fax: 786-592-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: IBETTY PAEZ
Title or Position: OWNER
Credential:
Phone: 786-219-7540