Healthcare Provider Details

I. General information

NPI: 1306695523
Provider Name (Legal Business Name): VITALCARE INTEGRATIVE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 OLD BRANCH AVE STE C104
CLINTON MD
20735-1628
US

IV. Provider business mailing address

8508 TOPAZ CT
CLINTON MD
20735-3342
US

V. Phone/Fax

Practice location:
  • Phone: 240-244-0731
  • Fax:
Mailing address:
  • Phone: 240-244-0731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FELICIA OGUNTOMI
Title or Position: OWNER
Credential:
Phone: 240-244-0731