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General NPI Number Information
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NPI Number | 1538636378
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Entity Type | Organization
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Legal Business Name | VIJUVIA LIFE CENTERS, LLC
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Dates
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Enumeration Date | 10/30/2018
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 3000 N ORANGE AVE STE C
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City | ORLANDO
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State | FL
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Zip | 32804-7613
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Country | US
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Telephone | 407-252-7206
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 N ORANGE AVE STE C
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City | ORLANDO
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State | FL
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Zip | 32804-7613
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Country | US
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Telephone | 407-252-7206
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. BRADLEY COLE
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Credential |
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Telephone | 407-252-7206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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