Healthcare Provider Details

I. General information

NPI: 1144862517
Provider Name (Legal Business Name): VITAL MED HEALTH SOLUTIONS APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15375 BARRANCA PKWY STE I101
IRVINE CA
92618-2209
US

IV. Provider business mailing address

15375 BARRANCA PKWY STE I101
IRVINE CA
92618-2209
US

V. Phone/Fax

Practice location:
  • Phone: 949-551-0868
  • Fax: 866-678-5321
Mailing address:
  • Phone: 949-551-0868
  • Fax: 866-678-5321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN E BOHM
Title or Position: CEO
Credential: MD
Phone: 949-551-0868