Provider Demographics
NPI:1578079752
Name:VITALITY M CENTER INC
Entity Type:Organization
Organization Name:VITALITY M CENTER INC
Other - Org Name:VITALITY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LAILA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAYAB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-832-1212
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92781-0424
Mailing Address - Country:US
Mailing Address - Phone:714-832-1212
Mailing Address - Fax:714-832-1221
Practice Address - Street 1:210 W MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7701
Practice Address - Country:US
Practice Address - Phone:714-832-1212
Practice Address - Fax:714-832-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-24
Last Update Date:2017-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty