Provider Demographics
NPI:1881582963
Name:VITALCARE FAMILY MEDICINE AND ANTI-AGING CLINIC, LLC
Entity type:Organization
Organization Name:VITALCARE FAMILY MEDICINE AND ANTI-AGING CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:LAZARO
Authorized Official - Last Name:RODRIGUEZ BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DHSC, RN
Authorized Official - Phone:407-405-5565
Mailing Address - Street 1:15404 SW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4302
Mailing Address - Country:US
Mailing Address - Phone:407-405-5565
Mailing Address - Fax:
Practice Address - Street 1:7951 RIVIERA BLVD STE 305
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-6437
Practice Address - Country:US
Practice Address - Phone:407-405-5565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care