Provider Demographics
NPI:1417145376
Name:VITALITY HEALTH & WELLNESS, INC
Entity Type:Organization
Organization Name:VITALITY HEALTH & WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PEDRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOJAI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:949-955-3100
Mailing Address - Street 1:2700 W. PACIFIC COAST HWY
Mailing Address - Street 2:#234
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663
Mailing Address - Country:US
Mailing Address - Phone:949-955-3100
Mailing Address - Fax:949-743-1440
Practice Address - Street 1:2700 W. PACIFIC COAST HWY
Practice Address - Street 2:#234
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663
Practice Address - Country:US
Practice Address - Phone:949-955-3100
Practice Address - Fax:949-743-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 8098171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty