Healthcare Provider Details

I. General information

NPI: 1588791693
Provider Name (Legal Business Name): CORAL REEF EKG ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 SW 152ND ST
VILLAGE OF PALMETTO BAY FL
33157-1778
US

IV. Provider business mailing address

8353 SW 124TH ST SUITE #208
MIAMI FL
33156-5851
US

V. Phone/Fax

Practice location:
  • Phone: 305-251-2500
  • Fax:
Mailing address:
  • Phone: 305-235-9078
  • Fax: 305-235-8290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateFL

VIII. Authorized Official

Name: GINO VITIELLO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-255-2500