Provider Demographics
NPI:1578702411
Name:VITAL IMAGE HEALTH, LLC
Entity Type:Organization
Organization Name:VITAL IMAGE HEALTH, LLC
Other - Org Name:VITAL IMAGE MED SPA AND ANTI-AGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-392-0034
Mailing Address - Street 1:900 GLADES RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6421
Mailing Address - Country:US
Mailing Address - Phone:561-392-0034
Mailing Address - Fax:800-928-7109
Practice Address - Street 1:900 GLADES RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6421
Practice Address - Country:US
Practice Address - Phone:561-392-0034
Practice Address - Fax:800-928-7109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42709261Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care