Healthcare Provider Details

I. General information

NPI: 1992940142
Provider Name (Legal Business Name): VITAPHONE U.S.A., CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7140 DEAN MARTIN DRIVE SUITE 700
LAS VEGAS NV
89118-4518
US

IV. Provider business mailing address

7140 DEAN MARTIN DRIVE SUITE 700
LAS VEGAS NV
89118-4518
US

V. Phone/Fax

Practice location:
  • Phone: 888-869-4015
  • Fax: 888-226-3339
Mailing address:
  • Phone: 888-869-4015
  • Fax: 888-226-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. BRADLEY F TRITLE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 702-374-1270