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General NPI Number Information
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NPI Number | 1427428887
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Entity Type | Organization
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Legal Business Name | VITALGENIX HEALTH & WELLNESS, LLC
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 1325 S INTERNATIONAL PKWY SUITE 2241
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City | LAKE MARY
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State | FL
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Zip | 32746-1695
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Country | US
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Telephone | 407-636-9663
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Fax | 407-636-9664
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Provider Business Mailing Address
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Address Line | 1325 S INTERNATIONAL PKWY SUITE 2241
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City | LAKE MARY
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State | FL
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Zip | 32746-1695
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Country | US
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Telephone | 407-636-9663
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Fax | 407-636-9664
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAUL ENRIQUE TAMAYO
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Credential | M.D.
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Telephone | 407-636-9663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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