Provider Demographics
NPI:1770218554
Name:VYTALYZE MINDS CORP
Entity type:Organization
Organization Name:VYTALYZE MINDS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSVALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-363-4001
Mailing Address - Street 1:2300 W 84TH ST STE 601
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5780
Mailing Address - Country:US
Mailing Address - Phone:305-363-4001
Mailing Address - Fax:305-363-4002
Practice Address - Street 1:2300 W 84TH ST STE 601
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5780
Practice Address - Country:US
Practice Address - Phone:305-363-4001
Practice Address - Fax:305-363-4002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VYTALYZE MINDS CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-18
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114993600Medicaid
FL672191OtherJCAHO