| Vitalis Wellness Center, Llc | |
|
330 W Oak St Kissimmee FL 34741-4443 | |
| (888) 348-7363 | |
| (888) 348-7363 |
| Full Name | Vitalis Wellness Center, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 330 W Oak St, Kissimmee, Florida |
| Authorized Official Name and Position | Jose Rivas (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8883487363 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitalis Wellness Center, Llc 330 W Oak St Kissimmee FL 34741-4443 Ph: (888) 348-7363 | Vitalis Wellness Center, Llc 330 W Oak St Kissimmee FL 34741-4443 Ph: (888) 348-7363 |
| NPI Number | 1922876580 |
|---|---|
| Provider Enumeration Date | 12/13/2023 |
| Last Update Date | 11/08/2024 |
| Medicare PECOS PAC ID | 6800321571 |
|---|---|
| Medicare Enrollment ID | O20241119002288 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922876580 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (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 |
| Provider Name | Emilio Santos |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1558314294 PECOS PAC ID: 7719998061 Enrollment ID: I20150226002085 |
| Provider Name | Lisbet Garrido Samon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770335168 PECOS PAC ID: 1153856885 Enrollment ID: I20241119000619 |
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