Provider Demographics
NPI:1578186235
Name:VITALITY VEIN CARE
Entity Type:Organization
Organization Name:VITALITY VEIN CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:697-502-2774
Mailing Address - Street 1:221 N PRESTON RD STE A
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-8653
Mailing Address - Country:US
Mailing Address - Phone:760-315-0832
Mailing Address - Fax:
Practice Address - Street 1:221 N PRESTON RD STE A
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8653
Practice Address - Country:US
Practice Address - Phone:760-315-0832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-28
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty