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General NPI Number Information
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NPI Number | 1548422439
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Entity Type | Organization
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Legal Business Name | VITAL HEALTH LLP
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Dates
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Enumeration Date | 07/01/2008
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Last Update Date | 06/26/2019
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Provider Practice Location Address
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Address Line | 32685 US HIGHWAY 281 N STE 120
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City | BULVERDE
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State | TX
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Zip | 78163-3272
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Country | US
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Telephone | 210-742-7300
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Fax | 210-742-7301
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Provider Business Mailing Address
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Address Line | PO BOX 1632
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City | MISSION
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State | TX
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Zip | 78573-0029
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Country | US
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Telephone | 956-584-3231
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARLOS R VILLALTA
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Credential | MD
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Telephone | 210-742-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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