Provider Demographics
NPI:1073055729
Name:BIO VITA MEDICAL CENTER LLC.
Entity Type:Organization
Organization Name:BIO VITA MEDICAL CENTER LLC.
Other - Org Name:BIO VITA WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YUNIOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BASULTO
Authorized Official - Suffix:
Authorized Official - Credentials:OWNRE
Authorized Official - Phone:786-773-5872
Mailing Address - Street 1:1490 W 49TH PL
Mailing Address - Street 2:401
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3148
Mailing Address - Country:US
Mailing Address - Phone:786-733-5872
Mailing Address - Fax:786-733-5872
Practice Address - Street 1:1490 W 49TH PL
Practice Address - Street 2:401
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3148
Practice Address - Country:US
Practice Address - Phone:786-733-5872
Practice Address - Fax:786-733-5872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty