Provider Demographics
NPI:1790418507
Name:VITAL PSYCH MD LLC
Entity Type:Organization
Organization Name:VITAL PSYCH MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-306-2618
Mailing Address - Street 1:6928 SW 39TH ST APT 208
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-2471
Mailing Address - Country:US
Mailing Address - Phone:610-306-2618
Mailing Address - Fax:949-863-6470
Practice Address - Street 1:6 WEST FLAGLER STREET
Practice Address - Street 2:SUITE 900
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130
Practice Address - Country:US
Practice Address - Phone:610-306-2618
Practice Address - Fax:949-863-6470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty