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General NPI Number Information
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NPI Number | 1144434622
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Entity Type | Individual
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Provider Name | STEVEN THOMAS VITALE C.P.O.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1005 W ORANGEBURG AVE STE A
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City | MODESTO
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State | CA
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Zip | 95350-4163
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Country | US
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Telephone | 209-575-1063
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Fax | 209-575-1065
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Provider Business Mailing Address
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Address Line | 1005 W ORANGEBURG AVE STE A
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City | MODESTO
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State | CA
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Zip | 95350-4163
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Country | US
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Telephone | 209-575-1063
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Fax | 209-575-1065
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225000000X
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Taxonomy Name | Orthotic Fitter
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License Number | CPO2516
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License Number State | CA
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