Provider Demographics
NPI:1447982418
Name:VITA HEALTH SOLUTIONS INC
Entity type:Organization
Organization Name:VITA HEALTH SOLUTIONS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AC ADAPTER POWERED MODE: 6V 1A
Authorized Official - Prefix:MS
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:AC ADAPTER POWERED M
Authorized Official - Phone:213-272-5626
Mailing Address - Street 1:2060 MARENGO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1353
Mailing Address - Country:US
Mailing Address - Phone:213-400-5565
Mailing Address - Fax:
Practice Address - Street 1:2060 MARENGO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1353
Practice Address - Country:US
Practice Address - Phone:213-400-5565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty