VIDALTIA CORP. NPI 1336008036

NPI Information

NPI: 1336008036
Provider Name: VIDALTIA CORP.
Classification: Internal Medicine - 207R00000X
Entity Type: Organization
Address: 6456 NW 5TH WAY
FORT LAUDERDALE, FL
ZIP 33309
Phone: (202) 802-0082

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NPI Details

VIDALTIA CORP. is an internal medicine in Fort Lauderdale, FL. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. VIDALTIA CORP. NPI is 1336008036. The provider is registered as an organization entity type.

The provider's business location address is:

6456 NW 5TH WAY
FORT LAUDERDALE, FL
ZIP 33309-112
Phone: (202) 802-0082

The provider's authorized official is Ezechiel Fenelon .
The authorized official title is Ceo and has the following contact phone number (202) 802-0082.

The enumeration date for this NPI number is 1/19/2026 and was last updated on 1/19/2026.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	No
2	261QH0100X	Clinic/Center	Health Service	No
3	261QI0500X	Clinic/Center	Infusion Therapy	No
4	261QP0904X	Clinic/Center	Public Health, Federal	No
5	261QP0905X	Clinic/Center	Public Health, State or Local	No
6	261QP2300X	Clinic/Center	Primary Care	No
7	261QP3300X	Clinic/Center	Pain	No
8	261QV0200X	Clinic/Center	VA	No
9	261QX0100X	Clinic/Center	Occupational Medicine	No
10	281P00000X	Chronic Disease Hospital		No
11	302F00000X	Exclusive Provider Organization		No
12	302R00000X	Health Maintenance Organization		No
13	305R00000X	Preferred Provider Organization		No
14	305S00000X	Point of Service		No
15	207R00000X	Internal Medicine		Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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