Healthcare Provider Details

I. General information

NPI: 1003732355
Provider Name (Legal Business Name): VITALEDGE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14340 BOLSA CHICA RD STE J-1
WESTMINSTER CA
92683-4868
US

IV. Provider business mailing address

14340 BOLSA CHICA RD STE J-1
WESTMINSTER CA
92683-4868
US

V. Phone/Fax

Practice location:
  • Phone: 71-472-3995
  • Fax:
Mailing address:
  • Phone: 71-472-3995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ROBERT SON
Title or Position: MANAGER
Credential:
Phone: 71-472-3995