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General NPI Number Information
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NPI Number | 1659172138
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Entity Type | Organization
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Legal Business Name | VITAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/21/2025
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 225 W HOSPITALITY LN STE 308
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3221
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Country | US
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Telephone | 840-237-2700
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Fax | 840-237-2727
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Provider Business Mailing Address
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Address Line | 225 W HOSPITALITY LN STE 308
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3221
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Country | US
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Telephone | 840-237-2700
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Fax | 840-237-2727
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JENELYN ALMONTE
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Credential |
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Telephone | 840-237-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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