MEDICARE: VITALITY MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	5456	NV

General Provider Information

NPI Number	:	1457591182
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALITY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	8785 W WARM SPRINGS RD
Second Line	:	SUITE 109
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1823
Country	:	US
Telephone Number	:	702-731-1200
Fax Number	:	702-736-6302

Provider Business Practice Location Address
First Line	:	8785 W. WARM SPRINGS RD.
Second Line	:	SUITE 109
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1823
Country	:	US
Telephone Number	:	702-731-1200
Fax Number	:	702-736-6302

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	SAMUEL ANTONIO MUJICA TRENCHE
Credential	:	M.D.
Telephone Number	:	702-731-1200

Provider Enumeration Date	:	02/20/2009
Last Update Date	:	02/20/2009

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Directions to “VITALITY MEDICAL CENTER ” Practice Location

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