# MEDICAL VITALITY CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043858012
- **Authorized official:** PATRICIA ANSON (DELEGATED OFFICAL)
- **Authorized official phone:** (305) 279-2276

## Contact information

- **Practice address:** 1845 CORDOVA RD STE 204, FORT LAUDERDALE, FL 33316-6100
- **Practice address phone:** (954) 361-3343
- **Mailing address:** 1845 CORDOVA RD STE 204, FORT LAUDERDALE, FL 33316-6100
- **Mailing address phone:** (954) 361-3343

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/20/2019
- **Last updated:** 12/20/2019