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1619829454 NPI number — VITA IPA MEDICAL GROUP, PC

NPI Number: 1619829454
Health Care Provider/Practitioner: VITA IPA MEDICAL GROUP, PC

Information about “1619829454” NPI (VITA IPA MEDICAL GROUP, PC) exists in 1619829454 in HTML format HTML  |  1619829454 in plain Text format TXT  |  1619829454 in PDF (Portable Document Format) PDF  |  1619829454 in an XML format XML  formats.

NPI Number : 1619829454 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619829454",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "VITA IPA MEDICAL GROUP, PC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2271 W MALVERN AVE # 1186",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FULLERTON",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92833-2106",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "213-296-0352",
    "MailingAddressFaxNumber": "213-277-8747",
    "FirstLinePracticeLocationAddress": "305 N HARBOR BLVD STE 219",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FULLERTON",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92832-1901",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "213-296-0352",
    "PracticeLocationAddressFaxNumber": "213-277-8747",
    "EnumerationDate": "02/12/2026",
    "LastUpdateDate": "02/12/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LIM",
    "AuthorizedOfficialFirstName": "PHILLIP",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DO",
    "AuthorizedOfficialTelephoneNumber": "213-296-0352",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "302R00000X",
        "TaxonomyName": "Health Maintenance Organization",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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