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General NPI Number Information
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NPI Number | 1346054608
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Entity Type | Organization
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Legal Business Name | VITALITY MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 02/05/2025
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 7154 SW 47TH ST # 7154-A
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City | MIAMI
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State | FL
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Zip | 33155-4664
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Country | US
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Telephone | 786-533-0299
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Fax | 786-821-0248
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Provider Business Mailing Address
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Address Line | 7154 SW 47TH ST # 7154-A
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City | MIAMI
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State | FL
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Zip | 33155-4664
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Country | US
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Telephone | 786-533-0299
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Fax | 786-821-0248
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Authorized Official
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Title or Position | MGR ADMINISTRATOR
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Name | MRS. LEONOR CASTILLO MARTINEZ
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Credential |
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Telephone | 786-533-0299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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