Healthcare Provider Details

I. General information

NPI: 1669252268
Provider Name (Legal Business Name): VITALITY TOGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 W SOUTH JORDAN PKWY STE 450
SOUTH JORDAN UT
84095-3946
US

IV. Provider business mailing address

PO BOX 550
RIVERTON UT
84065-0550
US

V. Phone/Fax

Practice location:
  • Phone: 801-919-3008
  • Fax:
Mailing address:
  • Phone: 801-919-3008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALISA ANDERSON
Title or Position: MANAGER
Credential:
Phone: 801-919-3008