| Vitality Palace Corp | |
|
13028 Sw 120 St Suite 9 Miami FL 33186 | |
| (305) 728-9763 | |
| Not Available |
| Full Name | Vitality Palace Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 13028 Sw 120 St, Miami, Florida |
| Authorized Official Name and Position | William Mazzei (PRES) |
| Authorized Official Contact | 3057289763 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitality Palace Corp 13028 Sw 120 St Suite 9 Miami FL 33186 Ph: (305) 728-9763 | Vitality Palace Corp 13028 Sw 120 St Suite 9 Miami FL 33186 Ph: (305) 728-9763 |
| NPI Number | 1568298636 |
|---|---|
| Provider Enumeration Date | 09/13/2024 |
| Last Update Date | 03/06/2025 |
| Medicare PECOS PAC ID | 7517480676 |
|---|---|
| Medicare Enrollment ID | O20250328002668 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568298636 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | William Mazzei |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972586501 PECOS PAC ID: 2365345063 Enrollment ID: I20040129001121 |
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