Provider Demographics
NPI:1528855343
Name:MEDIVITAL HEALTH CENTER LLC
Entity type:Organization
Organization Name:MEDIVITAL HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-764-9170
Mailing Address - Street 1:10540 NW 78TH ST APT 424
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-6089
Mailing Address - Country:US
Mailing Address - Phone:305-764-9170
Mailing Address - Fax:833-523-2326
Practice Address - Street 1:10550 NW 77TH CT STE 305
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2071
Practice Address - Country:US
Practice Address - Phone:786-782-7738
Practice Address - Fax:833-523-2326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center