MEDICARE: VITALITY HEALTH GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	G50054	CA

General Provider Information

NPI Number	:	1386970549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALITY HEALTH GROUP INC

Provider Business Mailing Address
First Line	:	7119 W SUNSET BLVD
Second Line	:	SUITE 408
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-4411
Country	:	US
Telephone Number	:	818-633-4177
Fax Number	:

Provider Business Practice Location Address
First Line	:	7119 W SUNSET BLVD
Second Line	:	SUITE 408
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-4411
Country	:	US
Telephone Number	:	818-633-4177
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DAVID F GLOSSBRENNER
Credential	:
Telephone Number	:	818-633-4177

Provider Enumeration Date	:	10/22/2009
Last Update Date	:	10/22/2009

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