Healthcare Provider Details

I. General information

NPI: 1275440976
Provider Name (Legal Business Name): VIMAMB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5657 HAMPTON PARK CIR
VERO BEACH FL
32966-2221
US

IV. Provider business mailing address

2843 FILLMORE ST APT 102
HOLLYWOOD FL
33020-4252
US

V. Phone/Fax

Practice location:
  • Phone: 786-687-2420
  • Fax:
Mailing address:
  • Phone: 786-687-2420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFF BRAZZLE
Title or Position: DIRECTOR OF BILLING
Credential: CPC
Phone: 786-687-2420