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General NPI Number Information
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NPI Number | 1659165405
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Entity Type | Organization
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Legal Business Name | VITALIS MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 2193 EAGLECLOUD DR
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City | HENDERSON
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State | NV
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Zip | 89074-1801
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Country | US
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Telephone | 702-418-9965
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Fax |
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Provider Business Mailing Address
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Address Line | 2193 EAGLECLOUD DR
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City | HENDERSON
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State | NV
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Zip | 89074-1801
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Country | US
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Telephone | 702-418-9965
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | YAMERI MONASTERIOS AMPARAN
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Credential |
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Telephone | 702-418-9965
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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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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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