Provider Demographics
NPI:1780849687
Name:VITAL LIVING LLC
Entity Type:Organization
Organization Name:VITAL LIVING LLC
Other - Org Name:LTP NATURAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICK
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:949-715-9321
Mailing Address - Street 1:305 N COAST HWY
Mailing Address - Street 2:STE P
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-1681
Mailing Address - Country:US
Mailing Address - Phone:949-715-9321
Mailing Address - Fax:949-340-5738
Practice Address - Street 1:305 N COAST HWY
Practice Address - Street 2:STE P
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-1681
Practice Address - Country:US
Practice Address - Phone:949-715-9321
Practice Address - Fax:949-340-5738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-145175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty