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General NPI Number Information
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NPI Number | 1336767516
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Entity Type | Organization
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Legal Business Name | VITAL HEALTHCARE SPECIALISTS LLC
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 4338 W THOMAS RD # U1
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City | PHOENIX
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State | AZ
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Zip | 85031-3878
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Country | US
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Telephone | 775-335-7450
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Fax |
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Provider Business Mailing Address
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Address Line | 4338 W THOMAS RD # U1
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City | PHOENIX
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State | AZ
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Zip | 85031-3878
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Country | US
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Telephone | 775-335-7450
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Fax | 602-825-1739
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | THEOPHILUS AKOH
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Credential | NP
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Telephone | 775-335-7450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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