Provider Demographics
NPI:1134372782
Name:VITAL FUNCTION, LLC
Entity type:Organization
Organization Name:VITAL FUNCTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:DEL CARMEN
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-306-6276
Mailing Address - Street 1:7040 W PALMETTO PARK RD
Mailing Address - Street 2:STE 4-254
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3407
Mailing Address - Country:US
Mailing Address - Phone:954-306-6276
Mailing Address - Fax:800-928-7109
Practice Address - Street 1:2704 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-2435
Practice Address - Country:US
Practice Address - Phone:954-306-6276
Practice Address - Fax:800-928-7109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDX178AMedicare PIN