Healthcare Provider Details

I. General information

NPI: 1962895961
Provider Name (Legal Business Name): VIGOR NATURAL HEALTH CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2015
Last Update Date: 03/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SE 164TH AVE SUITE 212
VANCOUVER WA
98683-1107
US

IV. Provider business mailing address

3200 SE 164TH AVE SUITE 212
VANCOUVER WA
98683-1107
US

V. Phone/Fax

Practice location:
  • Phone: 360-406-4884
  • Fax:
Mailing address:
  • Phone: 360-406-4884
  • 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 Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberNT60374417
License Number StateWA

VIII. Authorized Official

Name: DR. ARIEL MASTRICH
Title or Position: OWNER
Credential: ND
Phone: 503-880-2570