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General NPI Number Information
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NPI Number | 1043823578
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Entity Type | Organization
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Legal Business Name | VITALIZE NATUROPATHIC MEDICINE PC
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Dates
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Enumeration Date | 08/25/2020
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 1106 N LA CIENEGA BLVD STE 207
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-2493
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Country | US
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Telephone | 323-524-5859
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Fax |
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Provider Business Mailing Address
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Address Line | 7741 ROMAINE ST APT 11
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90046-6224
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Country | US
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Telephone | 323-590-1991
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RYAN NAMDARKHAN
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Credential | NMD
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Telephone | 323-524-5859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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