Healthcare Provider Details

I. General information

NPI: 1770410250
Provider Name (Legal Business Name): VYTAL SURGERY CENTER OF GLENDALE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E COLORADO ST STE 555
GLENDALE CA
91205-1620
US

IV. Provider business mailing address

425 E COLORADO ST STE 555
GLENDALE CA
91205-1620
US

V. Phone/Fax

Practice location:
  • Phone: 818-578-5125
  • Fax:
Mailing address:
  • Phone: 818-578-5125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID VAHEDI
Title or Position: CEO
Credential: MD
Phone: 818-578-5125