| Vietrulife Medical Spa Corp | |
|
216 Broadway Kissimmee FL 34741-5768 | |
| (407) 910-4040 | |
| Not Available |
| Full Name | Vietrulife Medical Spa Corp |
|---|---|
| Speciality | General Practice |
| Location | 216 Broadway, Kissimmee, Florida |
| Authorized Official Name and Position | Angel Rivera (CFO) |
| Authorized Official Contact | 3213332573 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vietrulife Medical Spa Corp 3772 Eagle Isle Cir Kissimmee FL 34746-1907 Ph: (321) 333-2573 | Vietrulife Medical Spa Corp 216 Broadway Kissimmee FL 34741-5768 Ph: (407) 910-4040 |
| NPI Number | 1518673433 |
|---|---|
| Provider Enumeration Date | 01/24/2023 |
| Last Update Date | 08/24/2023 |
| Medicare PECOS PAC ID | 9931553724 |
|---|---|
| Medicare Enrollment ID | O20230927003311 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518673433 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Jose E Rivas |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1952588188 PECOS PAC ID: 4284958562 Enrollment ID: I20150114001633 |
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