Healthcare Provider Details

I. General information

NPI: 1073081188
Provider Name (Legal Business Name): VITA-HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 TAFT ST STE 200
PEMBROKE PINES FL
33026-4387
US

IV. Provider business mailing address

12301 TAFT ST STE 200
PEMBROKE PINES FL
33026-4387
US

V. Phone/Fax

Practice location:
  • Phone: 954-880-0090
  • Fax: 305-421-0463
Mailing address:
  • Phone: 954-880-0090
  • Fax: 305-421-0463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID BRIAN PAKULA
Title or Position: CFO
Credential: AP, DOM
Phone: 954-880-0090