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General NPI Number Information
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NPI Number | 1558767376
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Entity Type | Organization
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Legal Business Name | VISTA BEHAVIORAL HEALTH, PLLC
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Dates
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Enumeration Date | 11/05/2014
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Last Update Date | 05/19/2020
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Provider Practice Location Address
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Address Line | 2718 LETAP CT UNIT 101
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City | LAND O LAKES
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State | FL
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Zip | 34638-7266
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Country | US
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Telephone | 813-475-4196
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Fax | 813-475-4794
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Provider Business Mailing Address
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Address Line | 10607 CAYMAN ISLE CT
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City | TAMPA
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State | FL
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Zip | 33647-3372
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Country | US
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Telephone | 813-390-7586
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Fax | 813-475-4794
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Authorized Official
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Title or Position | PRESIDENT
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Name | MUHAMMAD ALI
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Credential | MD
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Telephone | 813-390-7586
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | ME98572
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License Number State | FL
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