MEDICARE: MDC VITACARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1174464705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MDC VITACARE LLC

Provider Business Mailing Address
First Line	:	9930 SW 40TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3944
Country	:	US
Telephone Number	:	786-558-4449
Fax Number	:	786-936-6655

Provider Business Practice Location Address
First Line	:	9930 SW 40TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3944
Country	:	US
Telephone Number	:	786-558-4449
Fax Number	:	786-936-6655

Authorized Official
Title or Position	:	OWNER
Name	:	MABY DE LA CARIDAD GONZALEZ PRIETO
Credential	:
Telephone Number	:	786-558-4449

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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Directions to “MDC VITACARE LLC ” Practice Location

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