Healthcare Provider Details

I. General information

NPI: 1730005166
Provider Name (Legal Business Name): VITALITY MEDICAL CARE OF ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11579 E VIA SALIDA
YUMA AZ
85367-7262
US

IV. Provider business mailing address

11579 E VIA SALIDA
YUMA AZ
85367-7262
US

V. Phone/Fax

Practice location:
  • Phone: 800-570-8160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK DORNER
Title or Position: MANAGER
Credential:
Phone: 800-570-8160