| Bon Vitas Medical Llc | |
|
5979 Vineland Rd Ste 209 Orlando FL 32819-7855 | |
| (407) 592-0949 | |
| Not Available |
| Full Name | Bon Vitas Medical Llc |
|---|---|
| Speciality | General Practice |
| Location | 5979 Vineland Rd Ste 209, Orlando, Florida |
| Authorized Official Name and Position | Melissa Ortiz Miranda (CEO) |
| Authorized Official Contact | 4075920949 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bon Vitas Medical Llc 15520 Waterleigh Cove Dr Winter Garden FL 34787-9208 Ph: (407) 592-0949 | Bon Vitas Medical Llc 5979 Vineland Rd Ste 209 Orlando FL 32819-7855 Ph: (407) 592-0949 |
| NPI Number | 1750027660 |
|---|---|
| Provider Enumeration Date | 05/12/2022 |
| Last Update Date | 05/13/2022 |
| Medicare PECOS PAC ID | 9638544141 |
|---|---|
| Medicare Enrollment ID | O20230417000255 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750027660 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Melissa Ortiz Miranda |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295063089 PECOS PAC ID: 0143464479 Enrollment ID: I20130926000287 |
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