| Vidaltia | |
|
6456 Nw 5th Way Fort Lauderdale FL 33309-6112 | |
| (202) 802-0082 | |
| Not Available |
| Full Name | Vidaltia |
|---|---|
| Speciality | Internal Medicine |
| Location | 6456 Nw 5th Way, Fort Lauderdale, Florida |
| Authorized Official Name and Position | Ezechiel Fenelon (CEO) |
| Authorized Official Contact | 2028020082 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vidaltia 6456 Nw 5th Way Fort Lauderdale FL 33309-6112 Ph: (202) 802-0082 | Vidaltia 6456 Nw 5th Way Fort Lauderdale FL 33309-6112 Ph: (202) 802-0082 |
| NPI Number | 1336008036 |
|---|---|
| Provider Enumeration Date | 01/19/2026 |
| Last Update Date | 05/26/2026 |
| Certification Date | 05/26/2026 |
| Medicare PECOS PAC ID | 4880169150 |
|---|---|
| Medicare Enrollment ID | O20260406000852 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336008036 | NPI | - | NPPES |
| Provider Name | Serena Garlande Bebe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598341778 PECOS PAC ID: 0143769117 Enrollment ID: I20240822002505 |
| Provider Name | Omari a Ruffin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1235320052 PECOS PAC ID: 0941493407 Enrollment ID: I20260409000347 |
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