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General NPI Number Information
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NPI Number | 1902625775
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Entity Type | Organization
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Legal Business Name | VITAL PRO HEALTH PLLC
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 2007 152ND AVE NE
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City | REDMOND
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State | WA
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Zip | 98052-5521
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Country | US
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Telephone | 425-453-6838
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Fax | 425-456-0106
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Provider Business Mailing Address
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Address Line | 2007 152ND AVE NE
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City | REDMOND
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State | WA
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Zip | 98052-5521
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Country | US
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Telephone | 425-453-6838
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Fax | 425-456-0106
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Authorized Official
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Title or Position | CO-OWNER
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Name | YAKOV GRINBERG
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Credential | MD
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Telephone | 425-453-6838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine 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 | 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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