Healthcare Provider Details

I. General information

NPI: 1336731660
Provider Name (Legal Business Name): VANGUARD HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8241 SW 124TH ST
PINECREST FL
33156-5900
US

IV. Provider business mailing address

14109 S DIXIE HWY
PALMETTO BAY FL
33176-7223
US

V. Phone/Fax

Practice location:
  • Phone: 786-254-5834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAUL PUIG
Title or Position: PRESIDENT
Credential:
Phone: 786-254-5834