Provider Demographics
NPI:1942003942
Name:VITALICARE WELLNESS CENTER LLC
Entity type:Organization
Organization Name:VITALICARE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:F
Authorized Official - Last Name:RASUA VELOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-805-2642
Mailing Address - Street 1:10700 CARIBBEAN BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1232
Mailing Address - Country:US
Mailing Address - Phone:786-548-6774
Mailing Address - Fax:
Practice Address - Street 1:10700 CARIBBEAN BLVD STE 402
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1232
Practice Address - Country:US
Practice Address - Phone:786-548-6774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health