Organization
VITAL RADIANCE WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER WAYNE LUCZYWO (PRACTICE MANAGER)
(407) 974-3500
Entity
Organization
Contact information
Practice address
29 W SMITH ST, WINTER GARDEN, FL 34787-3582
(407) 974-3500
Mailing address
29 W SMITH ST, WINTER GARDEN, FL 34787-3582
(407) 974-3500
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
—
—
2083B0002X
Obesity Medicine (Preventive Medicine) Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
09/06/2025
Last updated
09/06/2025
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