Provider Demographics
NPI:1922876580
Name:VITALIS WELLNESS CENTER
Entity Type:Organization
Organization Name:VITALIS WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-348-7363
Mailing Address - Street 1:318 N JOHN YOUNG PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4927
Mailing Address - Country:US
Mailing Address - Phone:407-901-9112
Mailing Address - Fax:888-348-7363
Practice Address - Street 1:318 N JOHN YOUNG PKWY STE 1
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4927
Practice Address - Country:US
Practice Address - Phone:407-901-9112
Practice Address - Fax:888-348-7363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-13
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center