Provider Demographics
NPI:1720812381
Name:HUMANIS VITA HEALTH CARE LLC
Entity type:Organization
Organization Name:HUMANIS VITA HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:786-234-7253
Mailing Address - Street 1:4445 W 16TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7190
Mailing Address - Country:US
Mailing Address - Phone:786-778-7449
Mailing Address - Fax:786-685-3908
Practice Address - Street 1:4445 W 16TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7190
Practice Address - Country:US
Practice Address - Phone:786-778-7449
Practice Address - Fax:786-685-3908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center