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General NPI Number Information
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NPI Number | 1417835232
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Entity Type | Organization
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Legal Business Name | VITALITY SPA LLC
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Dates
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Enumeration Date | 08/21/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 4380 CHERRY AVE NE
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City | KEIZER
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State | OR
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Zip | 97303-4855
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Country | US
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Telephone | 503-479-7111
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Fax |
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Provider Business Mailing Address
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Address Line | 4380 CHERRY AVE NE
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City | KEIZER
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State | OR
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Zip | 97303-4855
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Country | US
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Telephone | 503-479-7111
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Fax |
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Authorized Official
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Title or Position | OWNER/ADVANCED AESTHETICIAN
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Name | PAUL R GARCIA
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Credential | CAE
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Telephone | 503-479-7111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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