Provider Demographics
NPI:1891466116
Name:VITAL WELLNESS, LLC
Entity Type:Organization
Organization Name:VITAL WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA LIZA
Authorized Official - Middle Name:ABANIEL
Authorized Official - Last Name:SAMPAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PT
Authorized Official - Phone:808-388-2690
Mailing Address - Street 1:2119 WAIOLA ST APT 104
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-2805
Mailing Address - Country:US
Mailing Address - Phone:808-388-2690
Mailing Address - Fax:
Practice Address - Street 1:2119 WAIOLA ST APT 104
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-2805
Practice Address - Country:US
Practice Address - Phone:808-388-2690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy