=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700730462
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VITACARE MEDICAL GROUP, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2026
-----------------------------------------------------
Last Update Date | 02/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10453 SW 40TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33165-3753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-684-6845
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11840 SW 25TH TER
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-2404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-684-6845
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MNG
-----------------------------------------------------
Name | IMAYACIL MARZO HERNANDEZ
-----------------------------------------------------
Credential | RN, MSN
-----------------------------------------------------
Telephone | 786-684-6845
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------