Provider Demographics
NPI:1346054608
Name:VITALITY MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:VITALITY MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEONOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-533-0299
Mailing Address - Street 1:7154 SW 47TH ST # 7154-A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4664
Mailing Address - Country:US
Mailing Address - Phone:786-533-0299
Mailing Address - Fax:786-821-0248
Practice Address - Street 1:7154 SW 47TH ST # 7154-A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4664
Practice Address - Country:US
Practice Address - Phone:786-533-0299
Practice Address - Fax:786-821-0248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care