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General NPI Number Information
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NPI Number | 1245298256
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Entity Type | Organization
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Legal Business Name | VITALITY HEALTHCARE MEDICAL CORP
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 16500 VENTURA BLVD SUITE 414
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City | ENCINO
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State | CA
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Zip | 91436-2011
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Country | US
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Telephone | 818-382-7880
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Fax | 818-382-7886
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Provider Business Mailing Address
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Address Line | 16500 VENTURA BLVD SUITE 414
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City | ENCINO
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State | CA
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Zip | 91436-2011
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Country | US
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Telephone | 818-382-7880
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Fax | 818-382-7886
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Authorized Official
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Title or Position | CEO
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Name | PEDRAM SHOJAI
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Credential | LAC
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Telephone | 818-382-7880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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