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General NPI Number Information
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NPI Number | 1538725940
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Entity Type | Organization
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Legal Business Name | VITA LINEA, LLC
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 03/29/2022
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Provider Practice Location Address
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Address Line | 333 NE 2ND ST
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City | DELRAY BEACH
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State | FL
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Zip | 33483-4522
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Country | US
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Telephone | 678-207-9575
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Fax |
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Provider Business Mailing Address
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Address Line | 333 NE 2ND ST
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City | DELRAY BEACH
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State | FL
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Zip | 33483-4522
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Country | US
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Telephone | 678-207-9575
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID NIKNAFS
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Credential |
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Telephone | 800-829-4933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) 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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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