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General NPI Number Information
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NPI Number | 1104372028
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Entity Type | Organization
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Legal Business Name | VITAL SCAN, LLC
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 08/31/2016
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Provider Practice Location Address
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Address Line | 3200 S. GESSNER ROAD UNIT #208
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City | HOUSTON
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State | TX
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Zip | 77063
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Country | US
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Telephone | 832-730-8042
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 S. GESSNER ROAD UNIT #208
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City | HOUSTON
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State | TX
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Zip | 77063
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Country | US
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Telephone | 832-730-8042
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. RONALD JOHN CAPARELLA
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Credential | CCI REGISTERED
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Telephone | 832-730-8042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | RUS#CCI 00011742
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License Number State |
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