Provider Demographics
NPI:1710323852
Name:VITAL HEALTH, LLC
Entity Type:Organization
Organization Name:VITAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRO
Authorized Official - Prefix:MRS
Authorized Official - First Name:QUIARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERRARD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:210-233-7093
Mailing Address - Street 1:755 E MULBERRY AVE
Mailing Address - Street 2:200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3129
Mailing Address - Country:US
Mailing Address - Phone:210-233-7070
Mailing Address - Fax:210-277-5199
Practice Address - Street 1:3619 PAESANOS PKWY
Practice Address - Street 2:STE 212
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1253
Practice Address - Country:US
Practice Address - Phone:210-690-5599
Practice Address - Fax:210-690-5595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty