Provider Demographics
NPI:1457784845
Name:VITAL HEALTH MEDICAL CENTER INC
Entity type:Organization
Organization Name:VITAL HEALTH MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-341-7829
Mailing Address - Street 1:1900 W 68TH ST APT B403
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4476
Mailing Address - Country:US
Mailing Address - Phone:305-541-7555
Mailing Address - Fax:305-541-7556
Practice Address - Street 1:1900 W 68TH ST APT B403
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4476
Practice Address - Country:US
Practice Address - Phone:305-541-7555
Practice Address - Fax:305-541-7556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service