MEDICARE: VITAL AIR

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	332B00000X	Durable Medical Equipment & Medical Supplies		CA

General Provider Information

NPI Number	:	1760684567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL AIR

Provider Business Mailing Address
First Line	:	935 RIVERSIDE AVE # 2C
Second Line	:	P.O. BOX 1532
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-2653
Country	:	US
Telephone Number	:	805-226-0325
Fax Number	:

Provider Business Practice Location Address
First Line	:	935 RIVERSIDE AVE # 2C
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-2653
Country	:	US
Telephone Number	:	805-226-0325
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KRYSTYNA R AMARAL
Credential	:
Telephone Number	:	805-226-0325

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	08/22/2020

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