Provider Demographics
NPI:1710644877
Name:VITALMIND MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:VITALMIND MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAIMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIAS SOCARRAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-227-8640
Mailing Address - Street 1:6461 ZA ZU PITTS AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-1687
Mailing Address - Country:US
Mailing Address - Phone:786-227-8640
Mailing Address - Fax:
Practice Address - Street 1:2619 W CHARLESTON BLVD STE D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2121
Practice Address - Country:US
Practice Address - Phone:702-805-3059
Practice Address - Fax:702-846-5423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty