Vidaltia Corp.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

VIDALTIA CORP.

Doing business as

Vidaltia

Practice address

6456 NW 5TH Way
Fort Lauderdale, FL 33309-6112

Phone

(202) 802-0082

NPI assigned

Jan 19, 2026

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Ezechiel Fenelon

Title

Ceo

Phone

(202) 802-0082

Specialties & licenses 15

Addresses

Other names 1

• Vidaltia Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Serena Garlande Bebe, APRN, FNP-BC

  • Family Nurse Practitioner
  • Coral Springs, FL
  • NPI 1598341778
  Medicare reassignment
• Omari Adisa Ruffin, M.D.

  • Emergency Medicine Physician
  • Detroit, MI
  • NPI 1235320052

  FL

  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1768780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779753600000",
    "number": "1336008036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6456 NW 5TH WAY",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333096112",
            "telephone_number": "202-802-0082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6456 NW 5TH WAY",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333096112",
            "telephone_number": "202-802-0082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIDALTIA CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-19",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A",
        "authorized_official_last_name": "FENELON",
        "authorized_official_first_name": "EZECHIEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "202-802-0082",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP0904X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, Federal",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QV0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, VA",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "281P00000X",
            "taxonomy_group": "",
            "desc": "Chronic Disease Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vidaltia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Janice Debra Victor, M.D.
• Shannan Victorino, APRN
• Victory Living Programs
• Victory Recovery House, LLC
• Ricardo I Vicuna, M.D.
• Vanessa Vieda, PA-C
• Vania Charity Vieta
• Michael P Vignogna, MD
• Ana Claudia Vigo Perez
• Shrestha Vijayendra

• Internal Medicine Physician in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.