Provider Demographics
NPI:1346472024
Name:VITALITY MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:VITALITY MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPALI
Authorized Official - Middle Name:
Authorized Official - Last Name:RASTOGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-461-1717
Mailing Address - Street 1:PO BOX 68131
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-8131
Mailing Address - Country:US
Mailing Address - Phone:520-461-1717
Mailing Address - Fax:520-461-1727
Practice Address - Street 1:7448 N LA CHOLLA BLVD
Practice Address - Street 2:LA CHOLLA CORPORATE CENTER
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2306
Practice Address - Country:US
Practice Address - Phone:520-461-1717
Practice Address - Fax:520-461-1727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center