Vitalgenix Health & Wellness, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

VITALGENIX HEALTH & WELLNESS, LLC

Practice address

1325 S International Pkwy
Suite 2241
Lake Mary, FL 32746-1695

Phone

(407) 636-9663

Fax

(407) 636-9664

NPI assigned

Sep 29, 2015

Last updated

Sep 29, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Raul Enrique Tamayo, M.D.NPI 1568437689

Title

Owner

Phone

(407) 636-9663

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Raul E. Tamayo, M.D.

  • Internal Medicine Physician
  • Lake Mary, FL
  • NPI 1568437689
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1443484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443484800000",
    "number": "1427428887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 S INTERNATIONAL PKWY",
            "address_2": "SUITE 2241",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327461695",
            "telephone_number": "407-636-9663",
            "fax_number": "407-636-9664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 S INTERNATIONAL PKWY",
            "address_2": "SUITE 2241",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327461695",
            "telephone_number": "407-636-9663",
            "fax_number": "407-636-9664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALGENIX HEALTH & WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-29",
        "last_updated": "2015-09-29",
        "status": "A",
        "authorized_official_last_name": "TAMAYO",
        "authorized_official_first_name": "RAUL",
        "authorized_official_middle_name": "ENRIQUE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-636-9663",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Lake Mary, FL
• Providers in Lake Mary, 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 Sep 29, 2015; 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.