Provider Demographics
NPI:1346748480
Name:VITALITY WELLNESS CENTER, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:VITALITY WELLNESS CENTER, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECREATRY
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARDI-WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:408-402-1849
Mailing Address - Street 1:413 OXFORD WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-6350
Mailing Address - Country:US
Mailing Address - Phone:408-402-1849
Mailing Address - Fax:
Practice Address - Street 1:1011 CENTER ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3703
Practice Address - Country:US
Practice Address - Phone:831-325-9691
Practice Address - Fax:831-295-6206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4888171100000X
CAAC4876171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty