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General NPI Number Information
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NPI Number | 1629576970
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Entity Type | Organization
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Legal Business Name | VITALIST HEALING TRADITIONS
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Dates
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Enumeration Date | 01/31/2018
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Last Update Date | 01/31/2018
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Provider Practice Location Address
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Address Line | 519 S BROADWAY
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City | YONKERS
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State | NY
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Zip | 10705-3256
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Country | US
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Telephone | 917-701-8549
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Fax |
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Provider Business Mailing Address
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Address Line | 5856 LIEBIG AVE
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City | BRONX
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State | NY
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Zip | 10471-2112
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Country | US
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Telephone | 917-701-8549
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Fax |
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Authorized Official
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Title or Position | NATUROPATHIC DOCTOR, ACUPUNCTURIST
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Name | DR. CARINA LUNA LOPEZ
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Credential | ND, LAC
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Telephone | 917-701-8549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | NY
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