Healthcare Provider Details

I. General information

NPI: 1902625775
Provider Name (Legal Business Name): VITAL PRO HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 152ND AVE NE
REDMOND WA
98052-5521
US

IV. Provider business mailing address

2007 152ND AVE NE
REDMOND WA
98052-5521
US

V. Phone/Fax

Practice location:
  • Phone: 425-453-6838
  • Fax: 425-456-0106
Mailing address:
  • Phone: 425-453-6838
  • Fax: 425-456-0106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: YAKOV GRINBERG
Title or Position: CO-OWNER
Credential: MD
Phone: 425-453-6838