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General NPI Number Information
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NPI Number | 1316970981
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Entity Type | Organization
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Legal Business Name | YOUR GOOD HEALTH MEDICAL GROUP PA
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 09/18/2009
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Provider Practice Location Address
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Address Line | 11000 PROSPERITY FARMS RD SUITE 206
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-3462
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Country | US
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Telephone | 561-622-4646
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Fax | 561-775-8625
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Provider Business Mailing Address
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Address Line | 11000 PROSPERITY FARMS RD SUITE 206
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-3462
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Country | US
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Telephone | 561-622-4646
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Fax | 561-775-8625
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Authorized Official
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Title or Position | OWNER
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Name | DAVID VASTOLA
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Credential | DO
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Telephone | 561-622-4646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS0003793
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License Number State | FL
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