=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992653752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VITAL PRO MEDICAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2026
-----------------------------------------------------
Last Update Date | 03/18/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5352 N HABANA AVE STE C
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33614-6838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-563-8293
-----------------------------------------------------
Fax | 813-315-6362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5352 N HABANA AVE STE C
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33614-6838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-563-8293
-----------------------------------------------------
Fax | 813-315-6362
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMIN
-----------------------------------------------------
Name | LAZARO MENENDEZ CEPERO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-563-8293
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------