Organization
VITALITANS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANISLEY LANZA DIAZ RN (PRESIDENT)
(813) 403-2567
Entity
Organization
Contact information
Practice address
2715 W SLIGH AVE, TAMPA, FL 33614-4343
(813) 403-2567
Mailing address
8809 W HAMILTON AVE, TAMPA, FL 33615-2723
(813) 403-2567
Taxonomy
Speciality
Code
Description
License number
State
2081N0008X
Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
208600000X
Surgery Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
09/24/2024
Last updated
09/24/2024
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