Provider Demographics
NPI:1891199949
Name:VITAGEN, INC.
Entity Type:Organization
Organization Name:VITAGEN, INC.
Other - Org Name:SMA HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAND
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTHIAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-391-6397
Mailing Address - Street 1:1039 STONY BROOK CT
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-1834
Mailing Address - Country:US
Mailing Address - Phone:909-391-6397
Mailing Address - Fax:909-621-2307
Practice Address - Street 1:1039 STONY BROOK CT
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-1834
Practice Address - Country:US
Practice Address - Phone:909-391-6397
Practice Address - Fax:909-621-2307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health