Provider Demographics
NPI:1366839656
Name:VITAL HEALTH MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:VITAL HEALTH MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:FILART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-499-1350
Mailing Address - Street 1:6245 DE LONGPRE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-8253
Mailing Address - Country:US
Mailing Address - Phone:323-499-1350
Mailing Address - Fax:323-798-3021
Practice Address - Street 1:6245 DE LONGPRE AVE FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-8253
Practice Address - Country:US
Practice Address - Phone:323-499-1350
Practice Address - Fax:323-798-3021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76022207QG0300X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H72757Medicare UPIN