| NPI | 1518673433 |
|---|---|
| Former Legal Business Name | VIETRULIFE MEDICAL SPA |
| Entity Type | Organization |
| Authorized Contact | ANGEL RIVERA CFO 321-333-2573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Enumeration Date | 2023-01-24 |
| Last Update Date | 2023-08-24 |