Provider Demographics
NPI:1376920520
Name:VITA INC
Entity Type:Organization
Organization Name:VITA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PULMONARY SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNEILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-725-7593
Mailing Address - Street 1:4302 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 141
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6635
Mailing Address - Country:US
Mailing Address - Phone:305-725-7593
Mailing Address - Fax:
Practice Address - Street 1:4302 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 141
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6635
Practice Address - Country:US
Practice Address - Phone:305-725-7593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT96642279C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2279C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical CareGroup - Single Specialty