# VIETRULIFE MEDICAL SPA CORP

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** VIETRULIFE MEDICAL SPA
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518673433
- **Authorized official:** MR. ANGEL RIVERA (CFO)
- **Authorized official phone:** (321) 333-2573

## Contact information

- **Practice address:** 216 BROADWAY, KISSIMMEE, FL 34741-5768
- **Practice address phone:** (407) 910-4040
- **Mailing address:** 3772 EAGLE ISLE CIR, KISSIMMEE, FL 34746-1907
- **Mailing address phone:** (321) 333-2573

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/24/2023
- **Last updated:** 08/24/2023