Healthcare Provider Details

I. General information

NPI: 1639979974
Provider Name (Legal Business Name): NEW VITA MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 BOLSA AVE STE P
WESTMINSTER CA
92683-5943
US

IV. Provider business mailing address

2108 N ST STE 11571
SACRAMENTO CA
95816-5712
US

V. Phone/Fax

Practice location:
  • Phone: 714-395-4648
  • Fax:
Mailing address:
  • Phone: 714-395-4648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: SIENA ELISA N ONA
Title or Position: OWNER
Credential: MD
Phone: 714-395-4648