MEDICARE: VITALIS MILK, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	132700000X	Dietary Manager
3	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1518845114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALIS MILK, LLC

Provider Business Mailing Address
First Line	:	6250 MOUNTAIN VISTA ST STE L-3D
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-2320
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6250 MOUNTAIN VISTA ST STE L-3D
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-2320
Country	:	US
Telephone Number	:	702-482-9570
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. DALTON GADAL
Credential	:
Telephone Number	:	702-482-9570

Provider Enumeration Date	:	08/22/2025
Last Update Date	:	06/15/2026

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Directions to “VITALIS MILK, LLC ” Practice Location

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