| Vista Behavioral Health, Pllc | |
|
2718 Letap Ct Unit 101 Land O Lakes FL 34638-7266 | |
| (813) 475-4196 | |
| (813) 475-4794 |
| Full Name | Vista Behavioral Health, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2718 Letap Ct Unit 101, Land O Lakes, Florida |
| Authorized Official Name and Position | Muhammad Ali (PRESIDENT) |
| Authorized Official Contact | 8133907586 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vista Behavioral Health, Pllc 10607 Cayman Isle Ct Tampa FL 33647-3372 Ph: (813) 390-7586 | Vista Behavioral Health, Pllc 2718 Letap Ct Unit 101 Land O Lakes FL 34638-7266 Ph: (813) 475-4196 |
| NPI Number | 1558767376 |
|---|---|
| Provider Enumeration Date | 11/05/2014 |
| Last Update Date | 05/19/2020 |
| Certification Date | 05/19/2020 |
| Medicare PECOS PAC ID | 2466762109 |
|---|---|
| Medicare Enrollment ID | O20151109000484 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558767376 | NPI | - | NPPES |
| 001476800 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | ME98572 (Florida) | Primary |
| Provider Name | Muhammad Ali |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013098169 PECOS PAC ID: 5496714933 Enrollment ID: I20100720000802 |
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