Healthcare Provider Details

I. General information

NPI: 1780973024
Provider Name (Legal Business Name): VITAS HEALTH SERVICES OF CALIFORNIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1343 N GRAND AVE SUITE 100
COVINA CA
91724-4020
US

IV. Provider business mailing address

1343 N GRAND AVE SUITE 100
COVINA CA
91724-4020
US

V. Phone/Fax

Practice location:
  • Phone: 877-868-4827
  • Fax: 877-283-0663
Mailing address:
  • Phone: 877-868-4827
  • Fax: 877-283-0663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS M WESTFALL
Title or Position: CEO
Credential:
Phone: 513-618-2230