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General NPI Number Information
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NPI Number | 1457314064
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Entity Type | Organization
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Legal Business Name | VITAL MEDICAL CENTER INC
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 8300 WEST FLASLER STREET SUITE #175
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City | MIAMI
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State | FL
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Zip | 33144-2098
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Country | US
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Telephone | 305-220-0300
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Fax | 305-220-1472
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Provider Business Mailing Address
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Address Line | 8300 W FLAGLER ST SUITE #175
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City | MIAMI
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State | FL
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Zip | 33144-6000
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Country | US
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Telephone | 305-220-0300
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Fax | 305-220-1472
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Authorized Official
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Title or Position | MD
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Name | FERNANDO JOSE LORA
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Credential | MD
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Telephone | 305-220-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME0045837
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License Number State | FL
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