MEDICARE: VITALCARE FAMILY MEDICINE AND ANTI-AGING CLINIC, 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1881582963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALCARE FAMILY MEDICINE AND ANTI-AGING CLINIC, LLC

Provider Business Mailing Address
First Line	:	15404 SW 19TH ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-4302
Country	:	US
Telephone Number	:	407-405-5565
Fax Number	:

Provider Business Practice Location Address
First Line	:	7951 RIVIERA BLVD STE 305
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-6437
Country	:	US
Telephone Number	:	407-405-5565
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERTO LAZARO RODRIGUEZ BAEZ
Credential	:	DHSC, RN
Telephone Number	:	407-405-5565

Provider Enumeration Date	:	06/26/2025
Last Update Date	:	06/26/2025

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