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General NPI Number Information
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NPI Number | 1578003380
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Entity Type | Organization
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Legal Business Name | VITALANT
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Dates
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Enumeration Date | 02/27/2017
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 10536 PETER A MCCUEN BLVD
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City | MATHER
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State | CA
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Zip | 95655-4128
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Country | US
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Telephone | 602-343-7127
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Fax | 916-366-2546
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Provider Business Mailing Address
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Address Line | 9305 E VIA DE VENTURA
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-3597
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Country | US
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Telephone | 480-675-5696
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Fax |
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Authorized Official
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Title or Position | CHIEF LEGAL & RISK OFFICER
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Name | BHAVI A SHAH
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Credential |
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Telephone | 480-675-5653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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