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General NPI Number Information
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NPI Number | 1881357580
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Entity Type | Organization
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Legal Business Name | VIP WELLNESS CENTER LLC
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Dates
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Enumeration Date | 10/19/2021
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 3222 HILLSDALE LN
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City | KISSIMMEE
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State | FL
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Zip | 34741-7562
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Country | US
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Telephone | 407-350-2120
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Fax |
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Provider Business Mailing Address
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Address Line | 2685 MAXWELL CT W
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City | KISSIMMEE
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State | FL
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Zip | 34743-5629
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Country | US
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Telephone | 239-333-9092
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. LOURDES M SARDINAS
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Credential | LMT
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Telephone | 239-333-9092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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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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