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General NPI Number Information
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NPI Number | 1417145376
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Entity Type | Organization
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Legal Business Name | VITALITY HEALTH & WELLNESS, INC
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 2700 W. PACIFIC COAST HWY #234
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City | NEWPORT BEACH
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State | CA
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Zip | 92663
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Country | US
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Telephone | 949-955-3100
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Fax | 949-743-1440
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Provider Business Mailing Address
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Address Line | 2700 W. PACIFIC COAST HWY #234
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City | NEWPORT BEACH
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State | CA
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Zip | 92663
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Country | US
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Telephone | 949-955-3100
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Fax | 949-743-1440
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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 | L.AC.
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Telephone | 949-955-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 8098
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License Number State | CA
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