Healthcare Provider Details

I. General information

NPI: 1104628676
Provider Name (Legal Business Name): VITALIA HOLISTICS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CALLE SAN ANTONIO N
GUAYAMA PR
00784-4719
US

IV. Provider business mailing address

G 38 CALLE BATEY REPARTO CAGUAX
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 939-229-2222
  • Fax:
Mailing address:
  • Phone: 939-229-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CLARA SOFIA SANTIAGO ROSADO
Title or Position: PRESIDENT AND TREASURER
Credential: ND
Phone: 939-229-2222