Provider Demographics
NPI:1083092407
Name:VITAL SHIP NATUROPATHIC FAMILY MEDICINE
Entity Type:Organization
Organization Name:VITAL SHIP NATUROPATHIC FAMILY MEDICINE
Other - Org Name:VITAL SHIP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:QAMAR-BUSLER
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:225-235-7744
Mailing Address - Street 1:1424 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-4618
Mailing Address - Country:US
Mailing Address - Phone:225-235-7744
Mailing Address - Fax:
Practice Address - Street 1:1424 W 7TH ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-4618
Practice Address - Country:US
Practice Address - Phone:225-235-7744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty