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General NPI Number Information
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NPI Number | 1104628676
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Entity Type | Organization
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Legal Business Name | VITALIA HOLISTICS CORP
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 1 CALLE SAN ANTONIO N
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City | GUAYAMA
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State | PR
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Zip | 00784-4719
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Country | US
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Telephone | 939-229-2222
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Fax |
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Provider Business Mailing Address
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Address Line | G 38 CALLE BATEY REPARTO CAGUAX
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 939-229-2222
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND TREASURER
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Name | DR. CLARA SOFIA SANTIAGO ROSADO
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Credential | ND
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Telephone | 939-229-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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