Healthcare Provider Details

I. General information

NPI: 1306362629
Provider Name (Legal Business Name): VITALITY MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27699 JEFFERSON AVE STE 210
TEMECULA CA
92590
US

IV. Provider business mailing address

27699 JEFFERSON AVE STE 210
TEMECULA CA
92590-2696
US

V. Phone/Fax

Practice location:
  • Phone: 951-389-0500
  • Fax: 951-389-0528
Mailing address:
  • Phone: 951-389-0500
  • Fax: 951-389-0528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BELL
Title or Position: PRESIDENT
Credential:
Phone: 951-389-0500