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General NPI Number Information
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NPI Number | 1083477202
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Entity Type | Organization
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Legal Business Name | VITALOGY SKIN LAB
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Dates
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Enumeration Date | 01/31/2024
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Last Update Date | 05/25/2025
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Provider Practice Location Address
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Address Line | 8950 SW 74TH CT STE 2205
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City | MIAMI
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State | FL
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Zip | 33156-3181
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Country | US
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Telephone | 305-563-7877
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Fax |
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Provider Business Mailing Address
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Address Line | 8950 SW 74TH CT STE 2205
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City | MIAMI
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State | FL
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Zip | 33156-3181
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Country | US
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Telephone | 305-563-7877
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | STEPHANIE LANDA
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Credential |
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Telephone | 305-567-7877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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