Provider Demographics
NPI:1720661663
Name:VITA MEDICAL GROUP INC
Entity type:Organization
Organization Name:VITA MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IBETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-219-7540
Mailing Address - Street 1:13028 SW 120TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4522
Mailing Address - Country:US
Mailing Address - Phone:786-592-2785
Mailing Address - Fax:786-592-1476
Practice Address - Street 1:13028 SW 120TH ST FL 1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4522
Practice Address - Country:US
Practice Address - Phone:786-592-2785
Practice Address - Fax:786-592-1476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health