Provider Demographics
NPI:1538738893
Name:VITALOGY HEALTHCARE LLC
Entity type:Organization
Organization Name:VITALOGY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAZARO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFARO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:786-452-9230
Mailing Address - Street 1:811 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3007
Mailing Address - Country:US
Mailing Address - Phone:786-452-9230
Mailing Address - Fax:786-703-3745
Practice Address - Street 1:811 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3007
Practice Address - Country:US
Practice Address - Phone:786-452-9230
Practice Address - Fax:786-703-3745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNUMBOther0973