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General NPI Number Information
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NPI Number | 1891457800
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Entity Type | Organization
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Legal Business Name | VITOLOGY MED LLC
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Dates
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Enumeration Date | 10/06/2021
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 7208 W SAND LAKE RD STE 302
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City | ORLANDO
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State | FL
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Zip | 32819-5279
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Country | US
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Telephone | 305-458-1605
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Fax |
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Provider Business Mailing Address
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Address Line | 15601 DAHOON HOLLY LN
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City | WINTER GARDEN
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State | FL
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Zip | 34787-4789
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Country | US
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Telephone | 305-458-1605
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PARTNER
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Name | RICARDO NIEVES-RAMOS
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Credential | MD
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Telephone | 904-629-5560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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