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General NPI Number Information
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NPI Number | 1457784845
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Entity Type | Organization
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Legal Business Name | VITAL HEALTH MEDICAL CENTER INC
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 1900 W 68TH ST APT B403
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City | HIALEAH
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State | FL
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Zip | 33014-4476
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Country | US
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Telephone | 305-541-7555
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Fax | 305-541-7556
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Provider Business Mailing Address
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Address Line | 1900 W 68TH ST APT B403
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City | HIALEAH
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State | FL
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Zip | 33014-4476
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Country | US
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Telephone | 305-541-7555
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Fax | 305-541-7556
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Authorized Official
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Title or Position | ADMIN
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Name | LUIS REYES
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Credential |
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Telephone | 786-341-7829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | FL
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