=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760081640
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | V & L MEDICAL CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2020
-----------------------------------------------------
Last Update Date | 01/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10300 SW 72ND ST STE 282
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-3035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-456-6674
-----------------------------------------------------
Fax | 305-456-5215
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10300 SW 72ND ST STE 282
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-3035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-456-6674
-----------------------------------------------------
Fax | 305-456-5215
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | VICTOR I CASTILLO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-456-6674
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------