Healthcare Provider Details

I. General information

NPI: 1346166451
Provider Name (Legal Business Name): VITAL SCOPE MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 AVALON BLVD
LOS ANGELES CA
90003-1959
US

IV. Provider business mailing address

8023 BEVERLY BLVD # 1584
LOS ANGELES CA
90048-4539
US

V. Phone/Fax

Practice location:
  • Phone: 323-488-3243
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN COHEN
Title or Position: DO
Credential: DO
Phone: 323-488-3243