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General NPI Number Information
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NPI Number | 1881582963
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Entity Type | Organization
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Legal Business Name | VITALCARE FAMILY MEDICINE AND ANTI-AGING CLINIC, LLC
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 7951 RIVIERA BLVD STE 305
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City | MIRAMAR
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State | FL
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Zip | 33023-6437
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Country | US
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Telephone | 407-405-5565
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Fax |
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Provider Business Mailing Address
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Address Line | 15404 SW 19TH ST
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City | MIRAMAR
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State | FL
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Zip | 33027-4302
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Country | US
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Telephone | 407-405-5565
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERTO LAZARO RODRIGUEZ BAEZ
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Credential | DHSC, RN
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Telephone | 407-405-5565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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