Healthcare Provider Details

I. General information

NPI: 1285543934
Provider Name (Legal Business Name): VITALIS HEALTH SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16410 W DURANGO ST
GOODYEAR AZ
85338-2448
US

IV. Provider business mailing address

16410 W DURANGO ST
GOODYEAR AZ
85338-2448
US

V. Phone/Fax

Practice location:
  • Phone: 623-742-3224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: RONALD RODRIGUEZ
Title or Position: OWNER
Credential:
Phone: 623-724-3224