Provider Demographics
NPI:1760131601
Name:PM VITAS LLC
Entity Type:Organization
Organization Name:PM VITAS LLC
Other - Org Name:CLINICA LA FAMILIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ LEYVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-603-9409
Mailing Address - Street 1:2639 WALNUT HILL LN STE 225
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-5699
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2639 WALNUT HILL LN STE 225
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-5699
Practice Address - Country:US
Practice Address - Phone:469-471-1539
Practice Address - Fax:469-654-4091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-19
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty