Healthcare Provider Details

I. General information

NPI: 1518845114
Provider Name (Legal Business Name): VITALIS MILK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6250 MOUNTAIN VISTA ST STE L-3D
HENDERSON NV
89014-2320
US

IV. Provider business mailing address

6250 MOUNTAIN VISTA ST STE L-3D
HENDERSON NV
89014-2320
US

V. Phone/Fax

Practice location:
  • Phone: 702-482-9570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. DALTON GADAL
Title or Position: MEMBER
Credential:
Phone: 702-482-9570