Provider Demographics
NPI:1689803876
Name:VITALE MEDICAL OASIS, PLLC
Entity Type:Organization
Organization Name:VITALE MEDICAL OASIS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LM
Authorized Official - Phone:206-518-8938
Mailing Address - Street 1:2100 E UNION ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2954
Mailing Address - Country:US
Mailing Address - Phone:206-518-8938
Mailing Address - Fax:206-329-2357
Practice Address - Street 1:2100 E UNION ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2954
Practice Address - Country:US
Practice Address - Phone:206-518-8938
Practice Address - Fax:206-329-2357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT 60020664175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty