Healthcare Provider Details

I. General information

NPI: 1356953830
Provider Name (Legal Business Name): VITAFUSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 E THUNDERBIRD RD STE 103
PHOENIX AZ
85022-5760
US

IV. Provider business mailing address

1940 E THUNDERBIRD RD STE 103
PHOENIX AZ
85022-5760
US

V. Phone/Fax

Practice location:
  • Phone: 623-293-3985
  • Fax:
Mailing address:
  • Phone: 623-293-3985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER S RAY
Title or Position: PRESIDENT
Credential: MD
Phone: 623-293-3985