Healthcare Provider Details

I. General information

NPI: 1639989551
Provider Name (Legal Business Name): VITAL CARE DME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 TIDAL BEACH AVE
ST AUGUSTINE FL
32095-0147
US

IV. Provider business mailing address

119 TIDAL BEACH AVE
ST AUGUSTINE FL
32095-0147
US

V. Phone/Fax

Practice location:
  • Phone: 407-766-4211
  • Fax:
Mailing address:
  • Phone: 407-766-4211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: FAIZ AHMAD FAIZ
Title or Position: MGR
Credential: CEO
Phone: 407-766-4211