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General NPI Number Information
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NPI Number | 1922728898
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Entity Type | Organization
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Legal Business Name | VITAL HEALTH CA MEDICAL GROUP
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Dates
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Enumeration Date | 08/31/2022
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 4944 WINDPLAY DR STE 112
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-9310
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Country | US
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Telephone | 202-309-9677
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Fax |
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Provider Business Mailing Address
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Address Line | 4944 WINDPLAY DR STE 112
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-9310
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | BROOKE JUNGI
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Credential |
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Telephone | 530-451-6234
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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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