Healthcare Provider Details

I. General information

NPI: 1992639256
Provider Name (Legal Business Name): VITAL FORTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 ELGIN AVE
LODI CA
95240-7901
US

IV. Provider business mailing address

241 ELGIN AVE
LODI CA
95240-7901
US

V. Phone/Fax

Practice location:
  • Phone: 772-315-0444
  • 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: SARBJIT SINGH GILL
Title or Position: OWNER
Credential:
Phone: 772-315-0444