Healthcare Provider Details

I. General information

NPI: 1548489024
Provider Name (Legal Business Name): VITALANT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10536 PETER A MCCUEN BLVD
MATHER CA
95655-4128
US

IV. Provider business mailing address

10536 PETER A MCCUEN BLVD
MATHER CA
95655-4128
US

V. Phone/Fax

Practice location:
  • Phone: 916-456-1500
  • Fax: 916-366-0791
Mailing address:
  • Phone: 916-456-1500
  • Fax: 916-366-0791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code331L00000X
TaxonomyBlood Bank
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number05D0615608
License Number StateCA

VIII. Authorized Official

Name: BHAVI A SHAH
Title or Position: CHIEF LEGAL & RISK OFFICER
Credential:
Phone: 480-675-5653