Provider Demographics
NPI:1629796313
Name:VITASHI
Entity Type:Organization
Organization Name:VITASHI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESAIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GHANEM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:650-257-0752
Mailing Address - Street 1:30 N GOULD ST STE R
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6317
Mailing Address - Country:US
Mailing Address - Phone:415-988-1224
Mailing Address - Fax:650-381-0108
Practice Address - Street 1:1860 EL CAMINO REAL STE 321
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3114
Practice Address - Country:US
Practice Address - Phone:650-552-8180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service