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General NPI Number Information
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NPI Number | 1164151700
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Entity Type | Organization
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Legal Business Name | OC VITALITY
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 02/25/2023
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Provider Practice Location Address
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Address Line | 130 S CHAPARRAL CT STE 150
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City | ANAHEIM
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State | CA
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Zip | 92808-2279
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Country | US
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Telephone | 949-215-1957
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Fax |
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Provider Business Mailing Address
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Address Line | 8215 E SOMERSET LN
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City | ANAHEIM
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State | CA
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Zip | 92808-2315
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DIMITRI GRUER
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Credential | DAOM, LAC
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Telephone | 949-632-6678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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