Healthcare Provider Details

I. General information

NPI: 1629576970
Provider Name (Legal Business Name): VITALIST HEALING TRADITIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 S BROADWAY
YONKERS NY
10705-3256
US

IV. Provider business mailing address

5856 LIEBIG AVE
BRONX NY
10471-2112
US

V. Phone/Fax

Practice location:
  • Phone: 917-701-8549
  • Fax:
Mailing address:
  • Phone: 917-701-8549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. CARINA LUNA LOPEZ
Title or Position: NATUROPATHIC DOCTOR, ACUPUNCTURIST
Credential: ND, LAC
Phone: 917-701-8549