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General NPI Number Information
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NPI Number | 1184382228
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Entity Type | Organization
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Legal Business Name | VITALI SURGERY CENTER
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Dates
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Enumeration Date | 12/06/2021
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 2555 E COLORADO BLVD # 306B
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City | PASADENA
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State | CA
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Zip | 91107-6622
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Country | US
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Telephone | 626-538-7296
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Fax |
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Provider Business Mailing Address
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Address Line | 2555 E COLORADO BLVD # 306B
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City | PASADENA
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State | CA
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Zip | 91107-6622
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Country | US
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Telephone | 626-538-7296
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | XIAOQI LI
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Credential |
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Telephone | 626-538-7296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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