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General NPI Number Information
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NPI Number | 1346472024
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Entity Type | Organization
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Legal Business Name | VITALITY MEDICAL GROUP, PLLC
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Dates
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Enumeration Date | 08/14/2009
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Last Update Date | 08/14/2009
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Provider Practice Location Address
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Address Line | 7448 N LA CHOLLA BLVD LA CHOLLA CORPORATE CENTER
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City | TUCSON
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State | AZ
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Zip | 85741-2306
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Country | US
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Telephone | 520-461-1717
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Fax | 520-461-1727
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Provider Business Mailing Address
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Address Line | PO BOX 68131
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City | TUCSON
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State | AZ
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Zip | 85737-8131
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Country | US
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Telephone | 520-461-1717
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Fax | 520-461-1727
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. DEEPALI RASTOGI
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Credential | MD
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Telephone | 520-461-1717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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