Provider Demographics
NPI:1659334779
Name:VITALE, KARLA SUE (DO)
Entity Type:Individual
Prefix:DR
First Name:KARLA
Middle Name:SUE
Last Name:VITALE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 EDINBURGH ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2895
Mailing Address - Country:US
Mailing Address - Phone:505-285-1437
Mailing Address - Fax:
Practice Address - Street 1:309 EDINBURGH ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2895
Practice Address - Country:US
Practice Address - Phone:505-285-1437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7366207Q00000X
NMA-1478-08207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2Z1716OtherHEALTHNET
AZ954140Medicaid
TXX0196037OtherTEXAS DPS
AZAZ0783160OtherBCBS
AZ7039717OtherAETNA
TXX0196037OtherTEXAS DPS
AZ1821293580Medicare Oscar/Certification
AZ2Z1716OtherHEALTHNET
AZ7039717OtherAETNA
AZ954140Medicaid
AZ1821293580Medicare NSC
AZ1659334779Medicare NSC
TX295948BYTA9Medicare PIN