Healthcare Provider Details

I. General information

NPI: 1205759081
Provider Name (Legal Business Name): VITALITY PROHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27422 PORTOLA PKWY STE 200
LAKE FOREST CA
92610-2836
US

IV. Provider business mailing address

27422 PORTOLA PKWY STE 200
LAKE FOREST CA
92610-2836
US

V. Phone/Fax

Practice location:
  • Phone: 949-324-2151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MOHAMMAD KHARAZMI
Title or Position: OWNER
Credential: MD
Phone: 949-324-2151