Provider Demographics
NPI:1083113054
Name:FUERZA VITAL MEDICAL INSTITUTE, CORP
Entity Type:Organization
Organization Name:FUERZA VITAL MEDICAL INSTITUTE, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:BENITEZ VILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-640-8530
Mailing Address - Street 1:3701 SW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3638
Mailing Address - Country:US
Mailing Address - Phone:305-553-8343
Mailing Address - Fax:305-640-8537
Practice Address - Street 1:3701 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3638
Practice Address - Country:US
Practice Address - Phone:305-553-8343
Practice Address - Fax:305-640-8537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12725235Z00000X
261QM1300X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty