Healthcare Provider Details

I. General information

NPI: 1093505174
Provider Name (Legal Business Name): VITALIA ADHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13095 SAN FERNANDO RD
SYLMAR CA
91342-3540
US

IV. Provider business mailing address

13095 SAN FERNANDO RD
SYLMAR CA
91342-3540
US

V. Phone/Fax

Practice location:
  • Phone: 818-669-1592
  • Fax:
Mailing address:
  • Phone: 818-669-1592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIZA NIKOGHOSYAN
Title or Position: CEO
Credential:
Phone: 818-669-1592