Provider Demographics
NPI:1043823578
Name:VITALIZE NATUROPATHIC MEDICINE PC
Entity type:Organization
Organization Name:VITALIZE NATUROPATHIC MEDICINE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAMDARKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:323-524-5859
Mailing Address - Street 1:7741 ROMAINE ST APT 11
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6224
Mailing Address - Country:US
Mailing Address - Phone:323-590-1991
Mailing Address - Fax:
Practice Address - Street 1:1106 N LA CIENEGA BLVD STE 207
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-2493
Practice Address - Country:US
Practice Address - Phone:323-524-5859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center