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General NPI Number Information
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NPI Number | 1184198442
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Entity Type | Organization
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Legal Business Name | VITALITY MEDICAL CENTER INC
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Dates
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Enumeration Date | 01/18/2019
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 1648 W GLENOAKS BLVD # 101
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City | GLENDALE
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State | CA
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Zip | 91201-1827
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Country | US
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Telephone | 818-805-0005
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Fax | 818-805-0050
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Provider Business Mailing Address
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Address Line | 1648 W GLENOAKS BLVD # 101
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City | GLENDALE
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State | CA
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Zip | 91201-1827
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Country | US
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Telephone | 818-805-0005
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Fax | 818-805-0050
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Authorized Official
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Title or Position | SECRETARY
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Name | LILIA SEROBIAN
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Credential |
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Telephone | 818-805-0005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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