Healthcare Provider Details

I. General information

NPI: 1134372782
Provider Name (Legal Business Name): VITAL FUNCTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 N UNIVERSITY DR
SUNRISE FL
33322-2435
US

IV. Provider business mailing address

7040 W PALMETTO PARK RD STE 4-254
BOCA RATON FL
33433-3407
US

V. Phone/Fax

Practice location:
  • Phone: 954-306-6276
  • Fax: 800-928-7109
Mailing address:
  • Phone: 954-306-6276
  • Fax: 800-928-7109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MARIA DEL CARMEN BELTRAN
Title or Position: OPERATING MANAGER
Credential:
Phone: 954-306-6276