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General NPI Number Information
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NPI Number | 1053287664
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Entity Type | Organization
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Legal Business Name | VITALITY MEDICAL SPA INC.
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Dates
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Enumeration Date | 10/13/2025
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 1221 ROSE AVE
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City | SELMA
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State | CA
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Zip | 93662-3227
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Country | US
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Telephone | 559-325-4447
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 340
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City | KINGSBURG
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State | CA
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Zip | 93631-0340
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Country | US
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Telephone | 559-325-4447
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. LETICIA ESCOTO
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Credential | MD
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Telephone | 559-334-4143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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