Provider Demographics
NPI:1427875145
Name:VITALITANS LLC
Entity type:Organization
Organization Name:VITALITANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANISLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANZA DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:813-403-2567
Mailing Address - Street 1:8809 W HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2723
Mailing Address - Country:US
Mailing Address - Phone:813-403-2567
Mailing Address - Fax:
Practice Address - Street 1:2715 W SLIGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4343
Practice Address - Country:US
Practice Address - Phone:813-403-2567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies