| Vitalgenix Health & Wellness, Llc | |
|
1325 S International Pkwy Suite 2241 Lake Mary FL 32746-1695 | |
| (407) 636-9663 | |
| (407) 636-9664 |
| Full Name | Vitalgenix Health & Wellness, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1325 S International Pkwy, Lake Mary, Florida |
| Authorized Official Name and Position | Raul Enrique Tamayo (OWNER) |
| Authorized Official Contact | 4076369663 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitalgenix Health & Wellness, Llc 1325 S International Pkwy Suite 2241 Lake Mary FL 32746-1695 Ph: (407) 636-9663 | Vitalgenix Health & Wellness, Llc 1325 S International Pkwy Suite 2241 Lake Mary FL 32746-1695 Ph: (407) 636-9663 |
| NPI Number | 1427428887 |
|---|---|
| Provider Enumeration Date | 09/29/2015 |
| Last Update Date | 09/29/2015 |
| Medicare PECOS PAC ID | 0345542981 |
|---|---|
| Medicare Enrollment ID | O20160113001892 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427428887 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Raul E Tamayo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568437689 PECOS PAC ID: 1658429428 Enrollment ID: I20090505000190 |
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