Healthcare Provider Details

I. General information

NPI: 1184382228
Provider Name (Legal Business Name): VITALI SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 E COLORADO BLVD # 306B
PASADENA CA
91107-6622
US

IV. Provider business mailing address

2555 E COLORADO BLVD # 306B
PASADENA CA
91107-6622
US

V. Phone/Fax

Practice location:
  • Phone: 626-538-7296
  • Fax:
Mailing address:
  • Phone: 626-538-7296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: XIAOQI LI
Title or Position: MANAGER
Credential:
Phone: 626-538-7296