Healthcare Provider Details

I. General information

NPI: 1407471550
Provider Name (Legal Business Name): VITAL CONNECT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 09/02/2025
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPT LA 25245
PASADENA CA
91185-2133
US

IV. Provider business mailing address

2870 ZANKER RD STE 100
SAN JOSE CA
95134-2133
US

V. Phone/Fax

Practice location:
  • Phone: 408-963-4600
  • Fax:
Mailing address:
  • Phone: 408-963-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: VITAL CONNECT
Title or Position: CEO
Credential:
Phone: 408-963-4600