Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Vidaltia Corp

Organization Internal Medicine Physician · NPI 1336008036

Vidaltia Corp is an Internal Medicine Physician in Fort Lauderdale, Florida. Registered with an NPI since 2026.

In the registry since
2026
Specialties on file
15
What do these letters mean?
Corp — Corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

6456 NW 5th Way
Fort Lauderdale, FL 33309-6112
Phone: (202) 802-0082
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X
Federally Qualified Health Center (FQHC) Taxonomy 261QF0400X
Health Service Clinic/Center Taxonomy 261QH0100X
Infusion Therapy Clinic/Center Taxonomy 261QI0500X
Federal Public Health Clinic/Center Taxonomy 261QP0904X
State or Local Public Health Clinic/Center Taxonomy 261QP0905X
Primary Care Clinic/Center Taxonomy 261QP2300X
Pain Clinic/Center Taxonomy 261QP3300X
VA Clinic/Center Taxonomy 261QV0200X
Occupational Medicine Clinic/Center Taxonomy 261QX0100X
Chronic Disease Hospital Taxonomy 281P00000X
Exclusive Provider Organization Taxonomy 302F00000X
Health Maintenance Organization Taxonomy 302R00000X
Preferred Provider Organization Taxonomy 305R00000X
Point of Service Taxonomy 305S00000X

Record details

NPI number1336008036
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Ezechiel Fenelon — Ceo · (202) 802-0082
Other names Vidaltia
NPI enumeratedJanuary 19, 2026
Last updated in NPPESMay 26, 2026
Certification dateMay 26, 2026
Mailing address6456 Nw 5th Way, Fort Lauderdale, FL 33309-6112

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