Provider Demographics
NPI:1871337352
Name:VITAL HEALTHCARE CENTERS CORP
Entity type:Organization
Organization Name:VITAL HEALTHCARE CENTERS CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANCHEZ BENITES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-681-4317
Mailing Address - Street 1:1601 N PALM AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3240
Mailing Address - Country:US
Mailing Address - Phone:646-342-5508
Mailing Address - Fax:
Practice Address - Street 1:1601 N PALM AVE STE 102
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3240
Practice Address - Country:US
Practice Address - Phone:646-342-5508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-20
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center