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General NPI Number Information
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NPI Number | 1730078346
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Entity Type | Organization
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Legal Business Name | LUXVITALITY MEDICAL CORP
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 3635 BRADSHAW RD STE B
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City | SACRAMENTO
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State | CA
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Zip | 95827-3277
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Country | US
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Telephone | 916-477-0661
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Fax |
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Provider Business Mailing Address
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Address Line | 368 LONE SPUR DR
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City | FOLSOM
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State | CA
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Zip | 95630-6176
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Country | US
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Telephone | 916-538-8184
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HAI DUY LE
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Credential | MD
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Telephone | 916-477-0661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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