Healthcare Provider Details

I. General information

NPI: 1578186235
Provider Name (Legal Business Name): VITALITY VEIN CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 N PRESTON RD STE A
PROSPER TX
75078-8653
US

IV. Provider business mailing address

221 N PRESTON RD STE A
PROSPER TX
75078-8653
US

V. Phone/Fax

Practice location:
  • Phone: 760-315-0832
  • Fax:
Mailing address:
  • Phone: 760-315-0832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AARON MICHAEL ROBERTS
Title or Position: PARTNER
Credential:
Phone: 713-449-2126